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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002639
Report Date: 06/21/2023
Date Signed: 06/21/2023 12:20:41 PM


Document Has Been Signed on 06/21/2023 12:20 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:ZHEN, XIAO XIA & ZHU, LISAFACILITY NUMBER:
384002639
ADMINISTRATOR:ZHEN, X. & ZHU, L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 509-6540
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:14CENSUS: 11DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Xiao Xia ZhenTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, Xiao Xia Zhen, her husband, and 2 helpers, and explained the purpose of the inspection. All adults had fingerprint clearance. The licensee's husband left the house for work during the inspection. 11 children including 3 infants with 2 helpers present. The daycare was called "XIN XIN FAMILY DAYCARE". The facility's operation hours were Monday to Friday from 8 AM to 6 PM. The licensee rented an in-law with a backyard in a 2 stories single-family house. Licensee lived in the in-law with her husband. Licensee's daughter and co-licensee (Lisa Zhu) rented the rooms on the upper level. Per the licensee, her daughter went to college now; she came back to visit her a couple of times per year. LPA toured and inspected the facility for health and safety hazards. The facility was clean and in order. Temperature and lighting were adequate. All toxins and harmful objects were either locked or made inaccessible to children. The daycare areas were the entire lower level, & backyard except for the licensee’s bedroom, a garage & a hallway. Off-limit areas were the entire upper level, the licensee’s bedroom on the lower level, the garage, the hallway on the lower level, and a storage room in the backyard. Licensee installed soft cushioning on the entire floor to prevent injury. Licensee also installed a Surveillance system in the daycare for security purposes. All electrical outlets were covered. There were plenty of age-appropriate toys, books, play structures, learning materials, and children’s furniture. They were in condition and repair. Cots were used for napping. Cubbies were available for children to store their belongings by the entrance. There was a fully charged 2A10BC fire extinguisher, a working telephone, working smoke, and carbon monoxide, and first aid supplies available in the daycare. Per the licensee, there were no guns, no weapons, and no pets in the house. The children’s bathroom was clean and free of harmful objects. The lower bathroom cabinet was latched. Childproof knobs were used at the doors to prevent children's access to the off-limit areas. Licensee provides breakfast, AM/PM snacks, lunch, and dinner to daycare children. The outdoor play yard was completely fenced. It was clean and in order. There were plenty of age-appropriate toys, a play structure with soft cushioning underneath to prevent injury, and ride-on toys available for children. Turf and rubber mats were installed on the entire playground as soft cushioning to prevent injury. A gate was used at the stairway in the yard. The licensee posted all the required postings. LPA also reviewed children's and staff files and obtained a copy of the current children's roster. The licensee subscribed to daycare insurance, it will expire on 11/16/2023. The licensee and 2 helpers had current Child Abuse Mandated Reporter Training (AB1207) and CPR & First Aid Training.

This report and notice of the site visit were discussed with the licensee and must be made available to the public upon request. For quarterly updates on Licensing information, go to the CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
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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