414004259-11-28-2023-05-CC-MTSO-CY22FL-20231128162142

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004259
Report Date: 11/28/2023
Date Signed: 11/28/2023 04:21:55 PM

Document Has Been Signed on 11/28/2023 04:21 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:	CHEN, YA		FACILITY NUMBER:	414004259
ADMINISTRATOR:	CHEN, YA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 345-0181
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 7	DATE:	11/28/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:21 PM
MET WITH:	Ya Chen		TIME COMPLETED:	04:30 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 November 28, 2023, Licensing Program Analyst (LPA) Tso conducted an unannounced, annual visit to the Family Child Care Home listed above. The LPA was granted entry by the Licensee, Ya Chen. LPA explained the purpose of the visit. LPA conduct the visit in Mandarin. Present during LPA's visit included licensee, licensee's spouse, licensee’s assistant, and 7 enrolled children (4 infants and 3 preschool age). The 7 children are supervised by the licensee and the licensee’s assistant. The license is operating within capacity limits and ratio during LPA's visit. Licensee lives in a 3-bedroom home with spouse and mother-in-law. All adults living in the home have fingerprint clearance on file. The hours of operation are Monday through Friday 8:00am to 6:00pm. The DAY CARE AREAS are the enclosed patio (listed on the facility sketch as kids room), family room and the hall bathroom. The front yard is used for outdoor activities. The OFF LIMIT AREAS are the 3 bedrooms, master bathroom, garage and backyard. The family room, kitchen and living room will be used to transition children from the enclosed patio to the hall bathroom. The Off-limit areas are properly barricaded with child safety gates and/or closed doors. The LPA and the licensee both performed careful inspections of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a combined smoke and carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPA did not find any walkers, bouncers, or other comparable objects during today’s inspection. According to the licensee, there are reportedly no firearms or other weapons on the premises. The LPA observed that a fishpond at the entrance of the home was covered with bolted gate on the metal gate cover. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

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 11/28/2023 04:21 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: CHEN, YA	FACILITY NUMBER: 414004259
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/28/2023

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 the record review, the licensee did not comply with the abovementioned section. The assistant has not completed the Mandated reporter training, or the training has expired which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	The licensee must ensure that all staff complete the Mandated Reporter Training bi-annually and are available for review during the inspection. The licensee states they will have the staff members complete the training and send the completion to the Licensing office by December 27, 2023.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

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: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, LPA confirmed licensee is not documenting infant napping conditions since 09/23 during each 15-minute review, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/01/2023
	Plan of Correction
1 2 3 4	Licensee will review Safe Sleep Regulations PIN 20-24 CCP; begin documenting infant napping conditions every 15 minutes, by the due date: 12/1/2023 Proof of correction will be submitted to the Licenaing via email.

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: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

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: CHEN, YA	FACILITY NUMBER: 414004259
	VISIT DATE: 11/28/2023

NARRATIVE

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The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The Licensee is aware that smoking is not permitted in a family childcare facility.

Bathroom for children's use was observed to be in proper working condition. LPA did not observe any hazardous materials to be accessible to children. The entire frontyard is fully enclosed and fenced. Outdoor area is equipped with a variety of toys and materials. There is a play structure in the frontyard that was observed to be in good condition. Flooring in frontyard includes artificial grass that was observed to be clean.
LPA reviewed five children’s records. Children’s files have a record of emergency identification information on file. Licensee's Pediatric First Aid/CPR is current and will expire 08/2024. Emergency drills are properly logged and maintained. Last emergency drill was conducted 08/3/2023. Licensee has licensing documentation properly posted and available for review. However, LPA found that the infant sleeping 15-minute check was up to September 2023 only. (Please refer to LIC 809D for citation.)

LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training. LPA did not find the Mandated Reporter training certificate in the assistant's file. (Please refer to LIC 809D for citation.)

Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

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.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

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: CHEN, YA	FACILITY NUMBER: 414004259
	VISIT DATE: 11/28/2023

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.

During the exit interview, the licensee, Ya Chen, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Please refer to LIC 809D for today’s citation. A copy of today’s report and the facility’s appeal rights were given to Ya Chen. The Notice of Site Visit was given to Ya Chen and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Ya Chen.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Man Tso	TELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC809 (FAS) - (06/04)

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