<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001816
Report Date: 02/02/2023
Date Signed: 02/02/2023 11:15:01 AM


Document Has Been Signed on 02/02/2023 11:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:LU, RITA RUEY-TINGFACILITY NUMBER:
414001816
ADMINISTRATOR:LU, RITA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 577-1715
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 8DATE:
02/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Rita Ruey- Ting LuTIME COMPLETED:
11:25 AM
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 2/2/2023 at 8:40AM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Rita Ruey- Ting Lu. Purpose of the inspection was explained and was for an unannounced, Annual Random inspection. Present in facility was the licensee and assistant caring for 8 children. All children are preschool age. Adults have criminal record clearances on file. Licensee’s home is a six bedroom, three bathroom, two story house. Days and Hours of operations are: Monday- Friday, 8:30 AM., to 5:30 PM. Day-care Areas: 1st Floor: Living Room (Playroom); Bathroom #1; Bedroom #1 (napping only); Outdoor Play Area, Family Room (Pass through only), and Kitchen (Pass through only). Off-limit Areas: Entire 2nd Floor: Bedroom #2, Bedroom #3, Bedroom #4, Bedroom #5, Bedroom #6, Bathroom #2, Bathroom #3 and First Floor: Garage. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 8:50AM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were clear of obstruction. Accessible furniture, materials, and books inspected were in good repair. Playroom has child sized table and chairs for food services. Fireplace is playroom has been barricaded. For storage, individual cubbies are located next to the main door. LPA observed napping mats and playpen (with tight-fitting sheet) in bedroom #1. Bathroom #1 was equipped with stepping stools, and adequate supplies for handwashing. Fixtures tested were in operating condition. Off-limit areas have been made inaccessible with child safety gates. Facility was the proper temperature, with ventilation and lighting. Diaper changing table is located playroom. Home had functioning telephone; smoke/ carbon monoxide combination detector; and fire extinguisher, 3A:40BC.

At 9:00AM., LPA inspected the outdoor play area. Area is enclosed with tall fencing.


At 9:05AM., Based on observations, LPA confirmed exposed wires on toy play car in outdoor area.
Outdoor play area does not any pools, fishponds, or bodies of water on the premises.
(REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
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 6


Document Has Been Signed on 02/02/2023 11:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: LU, RITA RUEY-TING
FACILITY NUMBER: 414001816

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:05AM., Based on observations, LPA confirmed exposed wires on toy play car in outdoor area. This poses a potential health and safety risk to children in care.
POC Due Date: 02/06/2023
Plan of Correction
1
2
3
4
Licensee will remove damaged toy from the outdoor area. Proof of correction will be submitted to the department via email.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:45AM., Based on record review, LPA confirmed proof of immunization are missing from several children's files.
POC Due Date: 02/10/2023
Plan of Correction
1
2
3
4
Licensee will file and children's proof of immunization by the due date: 2/10/2023. Proof of correction will be submitted to the department via email.
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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LU, RITA RUEY-TING
FACILITY NUMBER: 414001816
VISIT DATE: 02/02/2023
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
(Page 2)
At 9:30AM, LPA reviewed facility and children’s records.
At 9:35AM., Based on record review, LPA confirmed licensee missing staff's proof of immunization. Advisory Note: Technical Violation (LIC9102) was issued.

Children’s files were reviewed and included the: Admission Agreement; Identification of Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Notice of Additional Children in Care (LIC9150); and Consent for Medical Treatment (LIC627).

At 9:45AM., Based on record review, LPA confirmed proof of immunization missing from several children's files.

Licensee’s mandated reporter training was current, expiring 3/30/2024.


Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certifications were current expires 1/2024.
LPA reminded licensee to conduct disaster drill every six months. Advisory Note: Technical Violation (LIC9102TV) was issued.

Required posting are posted in visible location. Posting include the Childcare License, Notification Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of ill children is in playroom.

Per licensee, families provide all foods services for children in care. LPA reminded licensee to ensure children’s meal containers and items brought to facility are properly labeled. Per licensee, home does not have any firearms. Licensee has pet cat on site. Per licensee, pet has required vaccinations.

Licensee was reminded that all adults 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.


(REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LU, RITA RUEY-TING
FACILITY NUMBER: 414001816
VISIT DATE: 02/02/2023
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
(Page 3)
LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations and cited on 809D. Exit interview, plan of correction, appeal right, and reports were discussed with Licensee, Rita Ruey-Ting Lu, and signature of this form acknowledges receipt of these documents.



Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6