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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002639
Report Date: 07/16/2024
Date Signed: 07/16/2024 03:54:16 PM


Document Has Been Signed on 07/16/2024 03:54 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:
07/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Xiao Xia ZhenTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, Xiao Xia Zhen, and two helpers who have fingerprint clearance. The LPA explained the purpose of the inspection to the licensee. LPA observed 11 children including 2 infants and 9 preschoolers napping in the daycare areas upon LPA's arrival. The facility is called XIN XIN FAMILY DAYCARE and the operation hours are Monday to Friday from 8 AM to 6 PM. The licensee rents and lives with her husband in an in-law that includes 1 bedroom, a playroom, a main playroom, a bathroom, and a backyard. The licensee's daughter and a co-licensee (Lisa Zhu) rent the rooms on the upper level.
The daycare areas are the entire lower level, & backyard except for the licensee’s bedroom, a garage & a hallway behind the main playroom. The off-limit areas are the entire upper level, the licensee’s bedroom on the lower level, a garage, the hallway on the lower level, and a storage room in the backyard. LPA toured the facility for health and safety hazards. The facility was clean and in order, temperature and lighting were adequate, and toxins or harmful objects were made inaccessible to the children. The facility installed a surveillance camera at the main daycare entrance. The licensee also installed a gate at the pathway from the daycare entrance to prevent children from leaving the facility. There were plenty of age-appropriate toys, books, learning materials and equipment, and children's furniture available for children indoors. There was a fully charged 2A10BC fire extinguisher, a working cellular phone, and first aid supplies available in the daycare areas. The LPA did not test the hot wired 2in1 smoke and carbon monoxide detector due to napping, but LPA observed an indicator on the detector was green color. The facility had the right amount of cubbies with children's names available for the children to store their personal belongings by the main entrance. The licensee installed the soft cushioning on the entire daycare floor to prevent injury. The licensee covered all the electrical outlets and sharp corners in the daycare areas. A childproof knobs were installed to the doors of the bedroom and hallway. Boosters were available for feeding only. Playpens and cots were used for napping. The children's bathroom was clean and in order. The lower bathroom sink cabinets were latched. The outdoor play yard was completely fenced. The licensee installed the rubber cushioning underneath the play structure to prevent injury. Turf and rubber mats were installed in the entire play yard as soft cushioning to prevent injury. A gate was installed at the stairway to the upper level of the yard. Licensee provides breakfast, AM/PM snacks, lunch, and dinner to daycare children. Per the licensee, there were no guns, weapons, or pets in the house. The licensee posted all the required postings in the daycare areas. The LPA reviewed the children's files, staff files, and 15-minute nap check log, and obtained a copy of the current children's roster during the inspection. The facility subscribed to a Family Child Care Insurance that will expire in 11/2024. The licensee and helpers had current CPR/First Aid training and Child Abuse Mandated Reporter Training that will expire on 5/2025 and 6/2026.
continues in LIC809C
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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: ZHEN, XIAO XIA & ZHU, LISA
FACILITY NUMBER: 384002639
VISIT DATE: 07/16/2024
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Criminal Record Clearance - Licensee was reminded that all adults 18 and over living or working in home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Safe Sleep - LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ZHEN, XIAO XIA & ZHU, LISA
FACILITY NUMBER: 384002639
VISIT DATE: 07/16/2024
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MyChildCarePlan.org – Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law - During the exit interview, Zhen, Xiao Xia, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Notice of Site Visit - A notice of site visit was given and must remain posted for 30 days.

Exit Interview - Exit interview conducted and report was reviewed with the licensee, Zhen, Xiao Xia.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3