384002773-9-21-2023-05-CC-BVAN-CVW2BQ-20230921171530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002773
Report Date: 09/21/2023
Date Signed: 09/21/2023 05:15:37 PM

Document Has Been Signed on 09/21/2023 05:15 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:	WEN, JIAN		FACILITY NUMBER:	384002773
ADMINISTRATOR:	WEN, JIAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 370-4878
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY:	14	CENSUS: 5	DATE:	09/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Wen Jian		TIME COMPLETED:	05:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 21, 2023., Licensing Program Analyst (LPA) Van conducted an annual inspection at Licensee Jian Wen’s home. LPA explained the purpose of the inspection to the Licensee and was given access to the property. During the inspection, five children were supervised by the Licensee and her helper (2 infants and 3 preschoolers). The Licensee met the license capacity and limitation. All adults living or working in the house had undergone a criminal background check. The physical layout of the property remained unchanged, with the same off-limits and childcare areas. Childcare areas included the living room and bathroom, while the bedroom and kitchen were off-limits. The restricted daycare areas were appropriately blocked off from the children. Day Care Areas: on the ground floor, which includes the two small rooms, the living room, the bathroom, and the backyard. Off-limit areas are the garage and the entire second floor. The hours of operation are Monday to Friday, 8:00 am - 5:00 pm. All restricted daycare areas have been appropriately blocked off from the children. The Licensee's childcare areas were inspected and evaluated by LPA for any potential health and safety concerns. The childcare environment was clean, organized, and conducive to age-appropriate activities such as imaginary and manipulative play. The home was equipped with proper heating, lighting, and ventilation, and no defects or situations that could endanger children in care were detected. Additionally, the facility had a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a functional phone. A fully stocked first aid kit was also available for any children in need. LPA observed all unused electrical outlets were covered with a child-proof cover, and poisons, detergents, and cleaning agents were kept out of the reach of children. Continued on page 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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 4

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: WEN, JIAN	FACILITY NUMBER: 384002773
	VISIT DATE: 09/21/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

According to the Licensee, no firearms, weapons, or pets were on the premises, and no baby walkers, bouncers, or similar equipment were used in the daycare. The Licensee was informed that smoking is prohibited in family childcare facilities.

LPA reviewed and discussed the Safe Sleep Regulation with the Licensee. The Licensee was reminded by LPA of specific guidelines that must be followed when it comes to playpens and cribs. Specifically, it is advised not to keep any toys or pillows inside or any objects hanging above the cribs/playpens. The mattresses used should be designed specifically for the cribs/playpens, and bed sheets must be tightly fitted. LPA also informed the Licensee that checking on the infant every 15 minutes during naptime is mandatory. It is necessary to document these checks and keep them in the infant's file for review by the Department. As per the Licensee, regular fire and earthquake drills are carried out every six months. The most recent drill was conducted on August 14, 2023.

During the inspection, LPA thoroughly reviewed all records pertaining to the children under the licensee's care. The licensee was observed to maintain accurate records for each child, including vaccination records and parental rights forms. LPA further noted that each child had a complete emergency information card on file, which contained vital information such as the child's full name, phone number, and the location of a parent or authorized person who may be contacted in an emergency. In addition, the records also contained the name and phone number of the child's doctor and the parent's permission for the licensee to consent to emergency medical care if needed.

The licensee was found to comply with all required Licensing forms and had completed the necessary immunizations, Mandated Reporter Training AB 1207, and had proper daycare liability insurance. The licensee's Pediatric CPR/First Aid certification was valid until June 4, 2024. Furthermore, all the required paperwork, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights, were posted in a prominent location as mandated by law. Overall, the licensee's attention to detail and adherence to regulatory requirements demonstrate their commitment to providing a safe and secure environment for the children under their care.
Continued on page 3...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: WEN, JIAN	FACILITY NUMBER: 384002773
	VISIT DATE: 09/21/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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, prior to 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.

LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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 Evaluator Manual - 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
Continued on page 4...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: WEN, JIAN	FACILITY NUMBER: 384002773
	VISIT DATE: 09/21/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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.

During the exit interview, the LICENSEE, JIAN WEN, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

Licensee Jian Wen read and signed the report. During today's inspection, no deficiencies were discovered. Today's report and site visit notice was provided to the Licensee. LPA informed the Licensee that a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4