414002549-6-21-2023-05-CC-LGOZ-CSZVSR-20230621164158

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002549
Report Date: 06/21/2023
Date Signed: 06/21/2023 04:42:07 PM

Document Has Been Signed on 06/21/2023 04:42 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:	XU, JUN		FACILITY NUMBER:	414002549
ADMINISTRATOR:	XU, JUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 249-0298
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94065
CAPACITY:	14	CENSUS: 10	DATE:	06/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Jun Xu, Yimin Zhou, Zhifay Ma		TIME COMPLETED:	04:45 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 6/21/2023 at 1:55PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Assistant, Yimin Zhou. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility were two helpers caring for 10 children (3 infant age, 7 preschool age). Adults have criminal record clearances on file. Licensee, Jun Xu arrived during inspection. Licensee’s home is a one bedroom, one bathroom, one level unit. Days and Hours of operations are: Monday- Friday, 8:00AM.- 5:00PM. Day-care Areas: Living Room #1 (Playroom), Dining Area, Bathroom #1, Bedroom #1 and Patio Area. Off-limit Area: Kitchen. LPA inspected facility for health and safety hazards. At 2:00PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were clear of obstructions or hazards. Accessible furniture, toys and books inspected were in like-new condition. Child sized tables and chairs were available in dining room for seated activities. For napping services, LPA observed several mats stored in bedroom #1. At 2:10PM., Based on observations, LPA confirmed dirt build-up on infant feeding chairs in dining area. Advisory Note: Technical Violation (LIC9102TV) was issued. Bathroom #1 was maintained clean, with adequate supplies for hand washing. Fixture were in operating condition. Facility was the proper temperature, with ventilation and lighting. Home had functioning telephone service, smoke detector, carbon monoxide detector and fully charged fire extinguisher (2A:10BC). At 2:25PM., LPA inspected the outdoor patio area. Area is enclosed with tall fencing. Playthings inspected are in proper repair. Facility does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: XU, JUN	FACILITY NUMBER: 414002549
	VISIT DATE: 06/21/2023

NARRATIVE

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At 2:35PM, LPA reviewed facility and children’s records. Children’s files were reviewed and included the: Identification of Emergency Information (LIC700); Notification of Parent's Rights (LIC995); and Consent for Medical Treatment (LIC627).

At 2:55PM., Based on record review and interview, LPA confirmed licensee is not documenting infant napping conditions for each 15 minutes review.

LPA reminded licensee to maintain all children’s immunization records in facility files.

Staff files were reviewed during inspection. LPA reminded licensee to ensure staff proof of ‘Mandated Reporter Training’ (AD1207) are stored in personnel records. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee’s required Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 6/2024.

LPA reminded licensee is conduct, and document emergency disaster drills once every 6 months.

Required posting are posted, including Childcare License, Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC610A). Per licensee, isolation of an ill children is in the playroom.

LPA advised licensee to ensure all children’s meal containers brought by families must be labeled. Per licensee, home does not have any firearms.

Licensee was reminded 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 Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: XU, JUN	FACILITY NUMBER: 414002549
	VISIT DATE: 06/21/2023

NARRATIVE

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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, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations. In exit interview, evaluation report was discussed with Jun Xu, and licensee’s signature of this form acknowledges receipt of these documents.

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

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC809 (FAS) - (06/04)

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