414004119-5-10-2024-05-CC-MZAA-D55W2E-20240510165413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004119
Report Date: 05/10/2024
Date Signed: 05/10/2024 04:54:26 PM

Document Has Been Signed on 05/10/2024 04:54 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:	SHEN, YUNHAN		FACILITY NUMBER:	414004119
ADMINISTRATOR:	SHEN, YUNHAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(628) 800-2006
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	14	CENSUS: 12	DATE:	05/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Licensee, Yunhan Shen		TIME COMPLETED:	05:15 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 May 10th, 2024, at approximately 1:25pm, Licensing Program Analyst’s (LPAs) Melissa Zaragoza and Kassandra Medrano, conducted an unannounced, annual inspection. LPAs were greeted and granted access by facility staff, Leilani Tayag. Per staff, licensee was running errands and will arrive soon. At the entrance staff was explained the purpose of the inspection. Present during LPA's visit included 2 staff, and 12 children (1 infant and 11 preschool age). Hours of operation are Monday through Friday. 8:00am to 6:00pm. Licensee lives in the multi-level home. All adults living in the home and staff present, have fingerprint clearance on file. The DAY CARE AREAS are located on the second level of the home, that includes the bedroom #2 (napping room), bathroom #1, kitchen, living room, and hallways (walk through only). The OFF LIMIT AREAS are the entire first level of home, deck, bedroom #1, bedroom #3, and backyard. LPAs toured day care areas of home with staff, Prylie Astudillo. During inspection staff stated that they did not have access to staff and children’s files. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPAs reminded staff that cleaning supplies, such as poisons and hazardous materials need to be stored in home's high shelves and/or locked behind child safety locked cabinets. Home is equipped with a fully charged fire extinguisher and smoke and carbon monoxide detector. Smoke and carbon monoxide detectors were tested during visit and was observed to be in working condition. There are no pools, and bodies of water in the premises. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

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: SHEN, YUNHAN	FACILITY NUMBER: 414004119
	VISIT DATE: 05/10/2024

NARRATIVE

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Napping room (bedroom#2) was observed to be equipped with 11 cots for napping children and 1 mat. Cots were observed to be in good condition. LPAs reminded staff of the requirement for infant sleeping logs for napping. Logs are to be maintained and includes the 15-minute time check of when infant was last checked on and sleeping position.

Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. LPAs observed children’s diapers and wipes in living room to be properly labeled with each child’s individual names in cubbies. LPAs reminded staff, cubbies that are accessible to children shall not contain any medication or products that shall not be in reach of children. Per staff, children’s families provide diapers and wipes for children.

Children eat in kitchen. A food service is provided to children that includes breakfast, lunch, and snacks. LPAs observed eating area to be clean and equipped with appropriate dining furniture. LPAs observed knives to be made inaccessible.

Later during inspection, licensee arrived at approximately 2:15pm. At this time LPAs were provided with staff and children’s files. LPAs reviewed 12 children's records. LPAs reviewed licensee and staff records. Licensee has a current CPR/First Aid certification. Licensee's CPR/First Aid certification will expire 5/20/2025. During review it was found that staff were missing current and valid CPR. As well as 2/3 staff were missing current certificates for mandated reporter training. LPAs requested the childrens roster (LIC 9040) and licensee stated they have not used the required document.

Emergency disaster drills are conducted and are appropriately documented. Last disaster drill was conducted 03/28/2024. LPAs observed licensing documentation to be properly posted, made available for review. Per licensee, there are no weapons or firearms in the home.
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SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

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: SHEN, YUNHAN	FACILITY NUMBER: 414004119
	VISIT DATE: 05/10/2024

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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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

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/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Yunhan Shen, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed a Megan’s Law search on 05/03/2024.

California Code of Regulations, Tittle 22 deficiencies are being cited on the following pages:
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Yunhan Shen.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/10/2024 04:54 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: SHEN, YUNHAN	FACILITY NUMBER: 414004119
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

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 record review, the licensee did not comply with the section cited above.2/3 staff did not have current certificates for training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/10/2024
	Plan of Correction
1 2 3 4	Licensee to send copies of certificates to LPA by deadline.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Staff were present in facility without licensee and did not have current or valid CPR which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/10/2024
	Plan of Correction
1 2 3 4	Staff shall not be left alone with children until staff receive certificate. Licensee to provide proof of completion or give written statement stating staff will not be conducting training due to licensee being present in home at all times.

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) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC809 (FAS) - (06/04)

Page: 4 of 7

Document Has Been Signed on 05/10/2024 04:54 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: SHEN, YUNHAN	FACILITY NUMBER: 414004119
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 record review, the licensee did not comply with the section cited above in maintaing a childrens roster, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/10/2024
	Plan of Correction
1 2 3 4	Licensee to send childrens roster to LPA either via email or mail

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in maintaining infant sleeping logs for infants in care. Licensee currently has one infant enrolled, and licensee did not have sleeping logs recorded, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/10/2024
	Plan of Correction
1 2 3 4	Licensee to send childrens sleeping logs for infant starting next week (until child reaches 24 months) to LPA either via email or mail

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) 266-8827
LICENSING EVALUATOR NAME: Melissa Zaragoza	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC809 (FAS) - (06/04)

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