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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002423
Report Date: 08/09/2023
Date Signed: 08/09/2023 03:02:43 PM


Document Has Been Signed on 08/09/2023 03:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:YAN, XIAO LING & CHEN, MELODY HUAFACILITY NUMBER:
384002423
ADMINISTRATOR:YAN, XIAO LINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 333-3040
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 10DATE:
08/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Xiao Ling YanTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Yee conducted an Unannounced Required - 1 Year inspection today. The purpose of the visit was explained. LPA met with the licensee, Xiao Ling Yan, her husband and 10 children (3 infants). LPA toured the home with the licensee, Xiao. Current residents are Xiao Ling, her husband and their adult daughter. Daughter is moving out, LPA advised her to submit an updated application to remove her name from this license. She said she understands. Day-care areas:(lower level): kitchen, library, activities room, nap room located in the back, bathrooms, backyard and living room located in the 2nd level. The backyard is not in use at this time. Xiao is planning on remodeling the backyard. Once the backyard is completed with the remodeling, she will contact CCL for an inspection. The remaining areas of the house are off-limits. The facility personnel summary report was reviewed with Xiao during the inspection and updated. Both licensees' CPR, 1st aid expired on 05/01/2024.

LPA observed the home is clean orderly and properly ventilated. LPA also observed a 2A10BC Fire extinguisher, operable smoke detectors and carbon monoxide. There are no bodies of water in the home. Electrical outlets have child protective covers in place making them inaccessible to children. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. Kitchen/Bathroom cabinets/drawers have child protective locks in place making all sharp objects or toxic house hold items inaccessible to children. First aid supplies are available for children. Facility last fire/earthquake drill was conducted on 07/28/23. Disciplinary policy was discussed with Licensee today. Home has age appropriate toys and equipment available for the children in care. The facility provides meals.

LPA reviewed the children files. Children files are incomplete. LPA advised her to keep the files current. She said she understands.

See next page.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: YAN, XIAO LING & CHEN, MELODY HUA
FACILITY NUMBER: 384002423
VISIT DATE: 08/09/2023
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and
volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or
exemption, before initial presence in a licensed Family Child Care Home. A civil penalty of $100.00
minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is
provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding
ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301
(voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was reminded about Mandated Reporter Training available on the CCLD website www.ccld.ca.gov
or www.mandatedreporterca.com). Durning the inspection, the licensee, co-licensee AB1207 certificate were not available. Xiao said her daughter have the record and she is currently in China. She will submit a copy of the AB1207 when she returns on 08/14/23.

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and
recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased
equipment.

>This report was reviewed with the licensee. This report must be available in the facility for public review. Notice of site visit was given and must remain posted for 30 days.

Licensee was advised any additional questions to call Office, M-F, 8 am-5 pm, 650-266-8800 or
1-844-538-8766. Website: www.cdss.ca.gov
cclsanbrunocc@dss.ca.gov
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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