414002447-11-27-2023-05-CC-JTSE-CXYSU9-20231127131047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002447
Report Date: 11/27/2023
Date Signed: 11/27/2023 01:11:09 PM

Document Has Been Signed on 11/27/2023 01:11 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HUNG, YUK YING		FACILITY NUMBER:	414002447
ADMINISTRATOR:	HUNG, YUK YING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 401-5690
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	14	CENSUS: 10	DATE:	11/27/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Licensee, Yuk Ying Hung		TIME COMPLETED:	01:30 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 11/27/2023, at approximately 11:15AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Yuk Ying Hung. LPA explained the purpose of the visit. Present in the facility were Licensee, Licensee’s husband, helper, three infants and seven preschool age children. All adults working or living in the home have obtained fingerprint clearance and are associated to the facility. The facility is in compliance with capacity requirements. The home is a two-story, four bedroom, three-bathroom home. Daycare Areas: Living Room #2, Bedroom #3, Bedroom #4, Bathroom #2, Bathroom #3, and Backyard. Off-limits Areas: Living Room #1, the entire Upper Level, Bedroom #1, Bedroom #2, Bathroom #1, Kitchen, Storage Area, Shed in Backyard, and Garage. LPA and Licensee inspected the home for any health and safety hazards. The home is kept in clean and orderly condition. There are age-appropriate toys and learning materials present. Outlets in the home are childproof. Living Room #1 is only used for passage into the daycare area during drop-off. LPA observed that was at least one crib present for each infant enrolled at the facility. Preschoolers sleep in mats and use sheets that are brought from home. The sheets are then taken home and washed once a week. There is a piano present in Living Room #2. There are four combination smoke and carbon monoxide detectors present in the daycare area that are operational. There is no fireplace located in the daycare areas. The home is equipped with a fully charged 3A40BC fire extinguisher. There is a first aid kit that was observed to be fully equipped. Off-limits areas are barricaded and kept off-limits for children in care. Per Licensee, there are no firearms in the home. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUNG, YUK YING	FACILITY NUMBER: 414002447
	VISIT DATE: 11/27/2023

NARRATIVE

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The backyard was observed to be clean and free of debris. There is a play structure located in the backyard that has sufficient cushioning in the form of foam pads for children to play on. The equipment and play materials present in the backyard are kept clean and in good repair. There is a shack in the yard that is kept off-limits and locked. The yard is enclosed by a fence that is at least five feet high. There are two chickens in the yard that are fenced off and kept off-limits to children. There is also a cat present in the home that is kept in the off-limits areas.

LPA reviewed three staff files and nine children’s files. All children’s files were observed to be complete, and included immunization records, Identification and Emergency Information, and Notification of Parents’ Rights. Licensee provided infant sleep logs for review during the visit. LPA observed infant sleep logs to meet licensing requirements. Staff files were observed to have all Mandated Reporter Training certificates that expire on 4/2024, and First Aid/CPR certificates that expire on 3/2025. LPA discussed requirement to maintain staff immunization records.

Per Licensee, the last emergency drill was conducted on 10/11/2023. LPA reminded Licensee of requirement to document and maintain a record of all drills conducted. Per Licensee, children bring food from home to the facility. Staff may heat up food for children, but they do not provide food for children that is not brought from home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the 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.
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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUNG, YUK YING	FACILITY NUMBER: 414002447
	VISIT DATE: 11/27/2023

NARRATIVE

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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 22-02-CCP. 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/.

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, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Yuk Ying Huang.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

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