384002205-12-4-2023-05-CC-GLEG-CY846D-20231204174918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002205
Report Date: 11/20/2023
Date Signed: 12/04/2023 04:47:23 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2023 and conducted by Evaluator Brendon Van

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20231114123126

FACILITY NAME:	CHEN, XU MING		FACILITY NUMBER:	384002205
ADMINISTRATOR:	CHEN, XU MING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 566-8168
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY:	14	CENSUS: 11	DATE:	11/20/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Chu Tong Tang		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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-The facility did not adhere to the infant-safe sleep

INVESTIGATION FINDINGS:

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***THIS IS AN AMENDED REPORT TO CHANGE FROM CONFIDENTIAL TO PUBLIC REPORT***
On November 20, 2023., Licensing Program Analyst (LPA) Van conducted an unannounced complaint investigation and met with the Licensee’s assistants, ChuTong Tang and LanJuang Zeng. The Licensee was not at home. The purpose of the inspection was explained, and entry to the facility was granted. The two assistants supervised eleven children. Four infants and seven preschoolers. The facility met the teachers/children ratio. The Licensee, XuMing Chen, arrived home during the visit.

After entering the home, LPA followed the assistant and walked to the stairs leading to the childcare area. As soon as LPA got there, LPA heard a young infant crying from inside a nap room. The door to the room was closed. The assistants quickly opened the door and attended to one of the infants. LPA noticed that there were two infants inside, both of whom were wearing sleep sacks. LPA informed the assistant that using sleep sacks is not allowed according to the Infant Sleeping Plan. Based on LPA's observations, it was concluded that the allegation(s) is substantiated, according to the California Code of Regulations (Title 22, Div 12 Chp1), which is cited in the attached LIC9099D. The Type B citation can be found on the next page.

A notice of site visit was given to the Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

An exit interview was conducted, and the report was reviewed with the Licensee, XuMing Chen.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 05-CC-20231114123126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHEN, XU MING	FACILITY NUMBER: 384002205
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/30/2023 Section Cited CCR 102425(j)(5)	1 2 3 4 5 6 7	102425 Infant Safe Sleep (j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (5) If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. This requirment was not met, as evidenced by:	1 2 3 4 5 6 7	The Licensee is responsible for ensuring the safety of infants during nap times. This includes keeping the door of the napping room open at all times and removing all sleep sacks from the facility. The Licensee will also conduct a training session with staff members on the topic of infant safe sleep. The training materials and staff attendance will be sent to the LPA for review.
	8 9 10 11 12 13 14	Based on observation, LPA observed the napping room door was closed while infants were sleeping inside. In addition, the two infants were observed wearing a sleep sack. This poses potential health and safety risks to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

LIC9099 (FAS) - (06/04)

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