414002632-7-27-2023-05-CC-LTMO-CU5SN5-20230727140059

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002632
Report Date: 07/27/2023
Date Signed: 07/27/2023 02:01:08 PM

Document Has Been Signed on 07/27/2023 02:01 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:	HUANG, YAN		FACILITY NUMBER:	414002632
ADMINISTRATOR:	HUANG, YAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 288-2715
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	14	CENSUS: 9	DATE:	07/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Licensee, Yan Huang		TIME COMPLETED:	02:30 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 July 27th, 2023, at approximately 10:40AM, Licensing Program Analyst(LPA) Tapia-Mandujano conducted a Required Annual unannounced inspection at facility and met with licensee, Yan Huang. Purpose of the inspection was explained. Present in the home are licensee and two assistants caring for 9 children (2 infants and 7 preschool age). Also in the home is licensee's daughter. Per file review and interview, licensee's daughter is here for Summer Break but does not have fingerprint clearance Refer to LIC 809D for more details). All other adults living and or working in the home are fingerprint cleared and associated. Licensee owns home, which is a two-level house with 4 bedrooms, and two bathrooms. Licensee lives in the home with three other adults and two minor children. Hours of operation are Monday-Friday from 8:30am-6pm. Daycare areas are: Second Level;* Living room, bedroom # 1,2 and 3, Bathroom (next to the kitchen), Playroom (Connected to the a bedroom), and the gated portion of the upper backyard. Off limit areas are: kitchen (used to pass through to the backyard only), front yard, garage and basement room located next to the garage in the first level. All off limit areas are properly barricaded. Per licensee, she is currently not using Bedroom #1 and #3 but will like to keep them open. Per licensee, Bedroom #2 and playroom are used for sleeping only. LPA toured day care areas of home with Licensee to inspect for health and safety hazards. LPA observed home to be clean and in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which were in good condition. Home has a fireplace that is properly barricaded. There are no pools, and bodies of water in the premises. Licensee has a pet dog with proper documentation. All cleaning supplies, poisons and other chemicals were stored inaccessible to children. Discipline Policy was discussed. Isolation for sick children will be in the living room. Continued on Page 2...

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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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Document Has Been Signed on 07/27/2023 02:01 PM - 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUANG, YAN	FACILITY NUMBER: 414002632
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(d)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as there is an unfigerprinted adult living in the home, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/28/2023
	Plan of Correction
1 2 3 4	Licensee will get unfingerprinted adult fingerprinted and associated to the facility.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Marie Rodriguez	TELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUANG, YAN	FACILITY NUMBER: 414002632
	VISIT DATE: 07/27/2023

NARRATIVE

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There was a fully charged fire extinguisher, smoke alarm and carbon monoxide alarm, and a working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPA reviewed four children's record. LPA also reviewed facility records. Licensees CPR & First Aid Certificate will expire 06/2024. Licensee's mandated reporter training expires on 05/2024. Emergency drills must be conducted at least once every six months and should be properly logged.

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, 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 Child Care Center. 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.

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-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUANG, YAN	FACILITY NUMBER: 414002632
	VISIT DATE: 07/27/2023

NARRATIVE

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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.

**See following page for deficiencies cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1**

Type “A” violations were issued today. Licensee is advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. Notice of site Visit will be posted and should remain posted for 30 days, failure to post will result in an immediate civil penalty.

During the exit interview, the licensee, Yan Huang, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 7/26/2023.

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

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

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

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