414003081-2-21-2025-05-CC-DALO-DE4W38-20250221155531

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414003081
Report Date: 02/21/2025
Date Signed: 02/21/2025 03:55:53 PM

Document Has Been Signed on 02/21/2025 03:55 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:	YANG, JIA LING		FACILITY NUMBER:	414003081
ADMINISTRATOR/ DIRECTOR:	YANG, JIA LING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 260-1252
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	02/21/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:42 AM
MET WITH:	Jia Ling Yang		TIME VISIT/ INSPECTION COMPLETED:	04:25 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 2/21/2025, at approximately 8:47AM Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA entered through the main door of the home and rang the doorbell and did not have answer. LPA Alvarado called the licensee and stated that they are here for an annual inspection. The License came out to receive the LPA and notified the LPA that the main entrance to the facility is through the side of the home on the lower level. LPA Alvarado met with Licensee Jia Ling Yang(L1) and disclosed the purpose of the visit for today. Licensee owns the home with Husband. At 8:55AM LPA Alvarado observed Present in the Facility is (L1) and assistant supervising 9 children (3 Infant and 6 preschool age). Also present in the Facility was (L1) Mother-in-Law in a off limit area. Everyone in the household has fingerprint clearance and are associated to the facility. Daycare area: Entire Lower Level of the House and Back Yard. OFF limit area: Front of the Home, Entire 2nd Floor, Garage One and Two. At approximately 9:20AM LPA inspected the home for any health or safety hazards along with (L1). LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged 3-A:40-B:C fire extinguisher. Facility has a duo smoke and Carbon monoxide detector. At 9:20 LPA observed in the Infant Nap area inside the cribs a sleep sack, and loose articles LPA informed (L1) on infant safe sleep. (L1) removed the sleep sack immediately and stated it will be returned to the family. At Approximately 9:27AM LPA observed a bottle of disinfecting wipes on the children’s shelf as the assistant was wiping down areas, LPA reminded the assistant not to leave them out and the assistant removed immediately and placed them on a higher shelf making them inaccessible. Continued on Page 2...

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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: YANG, JIA LING	FACILITY NUMBER: 414003081
	VISIT DATE: 02/21/2025

NARRATIVE

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At 9:30AM LPA observed two bouncers, and no children present in them and reminded (L1) that any type of bay walkers and bouncers are not allowed in facilities. (L1) Stated she understood and will remove making them inaccessible.

Facility hours of operation are Monday-Friday 7:30AM-5:30PM. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Per (L1) Facility provides Breakfast, Lunch and Snack. (L1) also stated that the facility is nut free. (L1) stated that children bring blankets and sheets from home where they are sent home on Friday to be washed and returned Monday. (L1) stated that the facility does provide laundry if needed. Per (L1) there are no firearms present in the facility. All chemicals and Poisons are locked and made inaccessible to children. Phone number listed on file for Licensee is current.
No pools, hot tubs, spas, fishponds and or similar bodies of water observed on the property. Licensee also confirmed no bodies of water on property. Licensee has a current CPR/First Aid that will expire 4/2025.

LPA at approximately 11:00AM reviewed nine children’s files, and facility records. Required postings were observed to be posted.

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.

Continued on Page 3...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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: YANG, JIA LING	FACILITY NUMBER: 414003081
	VISIT DATE: 02/21/2025

NARRATIVE

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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.

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.

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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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: YANG, JIA LING	FACILITY NUMBER: 414003081
	VISIT DATE: 02/21/2025

NARRATIVE

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See LIC 809-D for deficiencies being cited today on 2/21/25 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Care & Supervision, Facility Administration, and Records.

See LIC9102-TV for Technical Violation issued today regarding Physical Plant and Records

See LIC9102-TA for Technical Advisory in regards to Physical Plant, Facility Administration, and Records.

Appeal rights were provided to Licensee Jia Ling Yang. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the exit interview, Licensee Jia Ling Yang, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee, Jia Ling Yang.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/21/2025 03:55 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: YANG, JIA LING	FACILITY NUMBER: 414003081
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Section Cited

CCR

102425(f)

Infant Safe Sleep

An infant shall not be swaddled while in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in one out of one objects. LPA Alvarado observed at 9:20AM a X-L sleep sack in the crib which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Licesnee will ensure that sleep sacks are not in use by infants in care. LPA Alvarado will do a return visit to confirm that sleep sacks are not being in use.

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 3 out of 3 persons who did not have Infant 15 Minutes Sleep Logs which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Licensee will ensure to docuemt Infant 15 Minutes for sleep logs, Licensee will submitt proof to LPA Alvarado of the Infant sleep logs via email by 3/7/25. LPA Alvarado will also do a return visit to confirm that the Infant sleep logs are being maintained.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

Page: 5 of 15

Document Has Been Signed on 02/21/2025 03:55 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: YANG, JIA LING	FACILITY NUMBER: 414003081
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in two out of two persons, Licensee and Assistant did not have Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Licesnee and assistant will take the complete Mandated Reporter Training and submitt proof to LPA Alvarado via Email by 3/7/25.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in one out of one object the licesnee has not maintained the current children roster which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Licensee will fill out and complete the Facility Roster and submitt proof via email to LPA Alvarado by 3/7/25. LPA Alvarado will aslo return to verify and ensure that the Facility Roster is being maintained.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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