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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003086
Report Date: 12/11/2023
Date Signed: 12/11/2023 04:10:47 PM


Document Has Been Signed on 12/11/2023 04:10 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:TRAN, ANDY N.FACILITY NUMBER:
414003086
ADMINISTRATOR:TRAN, ANDY N.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 281-1556
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:14CENSUS: 12DATE:
12/11/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Jaqueline VasquezTIME COMPLETED:
04:30 PM
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On December 11, 2023, @ approx.1:35 PM, Licensing Program Analyst (LPA) Maria Olguin-Leon met with helper, Jaqueline Vasquez for an unannounced annual inspection. The purpose of the inspection was explained. Present today was two helpers and 12 children (3 infants and 9 preschoolers). Per Licensee, he was on lunch and off for the remainder of the day. All adults working and living at facility have fingerprint clearance. Also present in home were two international students. Facility is operating within capacity/ratio limits. Hours of operation are Monday– Friday, 8:00 am - 5:30pm.

LPA and helper toured the backyard daycare room for health and safety hazards. Day Care Areas: Backyard daycare room and backyard. Off Limits Areas: Entire main home is off limits to daycare children. Helpers use kitchen for cooking purposes only. Daycare room is well light and has proper ventilation. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All electrical outlets are secured with child proof covers. There are plenty of age-appropriate toys, books, child size furnishings, learning material, and sleeping cots. Backyard has plenty of age-appropriate play toys, play structure and ride on toys all in good condition. Backyard is equipped with a cement patio and sand area to cushion falls. Backyard is surrounded with a 5 ft. fence. There are no spas, pools, or other bodies of waters.

Daycare room is equipped with a working dual carbon monoxide/smoke detector, LPA suggested detector be moved for easier accessibility. Home has a fully charged fire extinguisher. Isolation area for ill children will be outside daycare room under patio and away from other children. First aid kit is fully stocked with supplies. Per helper, Licensee uses a cell phone on the premises. Per helper, there are no weapons or firearms in the home. Parents provide sheets for playpens and are washed weekly or when soiled.

Cont. page 2…
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
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: TRAN, ANDY N.
FACILITY NUMBER: 414003086
VISIT DATE: 12/11/2023
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LPA reviewed 5 children’s records and 2 staff record. All children’s and staff files are complete. LPA reviewed children's roster. Helper’s CPR/FA and mandated reporter is current. Per helper, facility provides Breakfast, lunch, and dinner to children in care. LPA reminded helper to label children's food/bottles brought from home. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights posted. Per helper, last emergency drill was conducted in November, LPA viewed video of emergency drill being conducted, LPA reminded helper drills need to be properly documented. Liability insurance is provided by Acord effective through 02/2024.

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.

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/.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com.

Cont. page 3...
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: TRAN, ANDY N.
FACILITY NUMBER: 414003086
VISIT DATE: 12/11/2023
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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-and-resources/safe-sleep as an additional resource. LPAs 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. LPA reminded helper to document sleep logs. .

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.



Helper 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, the LICENSEE confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 11/22/2023. Helper texted Licensee for confirmation.

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.

Exit interview conducted and report was reviewed with the assistant, Jaqueline Vazquez.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6