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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004173
Report Date: 08/09/2023
Date Signed: 08/09/2023 01:27:46 PM

Document Has Been Signed on 08/09/2023 01:27 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:SHINING STAR BILINGUAL MONTESSORIFACILITY NUMBER:
384004173
ADMINISTRATOR:LUO, QUN XINGFACILITY TYPE:
850
ADDRESS:610 20TH STREETTELEPHONE:
(415) 881-1883
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94107
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 9DATE:
08/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Qun Xing LuoTIME COMPLETED:
01:30 PM
NARRATIVE
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On 8/9/2023, Licensing Program Analysts (LPAs), Leong and Van, made an unannounced case management visit to the child daycare facility listed above. The purpose of today's visit was in conjunction with the initial complaint visit on 8/9/2023. Based on a review of the records and an interview conducted during the complaint visit, the Director failed to disclose an unusual incident to the department within one business day and failed to submit an unusual incident report within seven business days. The LPAs were granted entry by the Director, Qun Xing Luo. The LPAs explained the purpose of the visit to the Director. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPAs observed the Director and one staff member supervising eight preschool aged children and one infant. Children's capacity and ratio requirements were observed to be in compliance.

During today’s visit, both LPAs discussed the importance of reporting an unusual incident report within the proper time. The LPAs will require the owner to go over reporting requirements with the entire staff. To correct the incident that took place on 7/31/2023, a plan of correction must be developed and submitted to the department. The facility will be assessed a Type B violation because of the incident that occurred on 7/31/2023. The LPAs communicated to the owner the information necessary for complying with the reporting requirements, which included a reference to the CCR 101212(d).

Please refer to LIC 809D for today’s citation.

A copy of today’s report, the “Notice of Site Visit” and their appeal rights were given to Qun Xing Luo. A “Notice of Site Visit” must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted, and the report was reviewed with Qun Xing Luo
Daniel J Oquendo
Hanson Leong
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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Document Has Been Signed on 08/09/2023 01:27 PM - It Cannot Be Edited


Created By: Hanson Leong On 08/09/2023 at 01:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SHINING STAR BILINGUAL MONTESSORI
FACILITY NUMBER: 384004173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2023
Section Cited

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101212 Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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Based on interview and record review, the licensee did not comply with the section cited, which poses a potential health, safety or personal rights risk to children in care.
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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


LIC809 (FAS) - (06/04)
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