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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005715
Report Date: 02/27/2025
Date Signed: 02/27/2025 01:21:58 PM

Document Has Been Signed on 02/27/2025 01:21 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:XA, WENDYFACILITY NUMBER:
214005715
ADMINISTRATOR/
DIRECTOR:		XA, WENDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 505-3158
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/27/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Applicant, Wendy XaTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On 2/27/2025, at approximately 9:30AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced case management visit at this address. LPA met with Applicant, Wendy Xa, and explained the purpose of the visit. Present during the visit was Applicant, three staff members, a fire inspector, six preschool age children, and two school-age children.

A prelicensing inspection was conducted on 1/8/2025 and Applicant was approved to operate as a small Family Child Care Home, pending fire clearance.

LPA inspected the home and observed there to be carbon monoxide detectors, fire alarms, and 2A10BC fire extinguishers present. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Electrical outlets are covered or blocked by furniture when not in use. There are age-appropriate toys and learning materials present. Furniture is free of rough or sharp edges.

LPA provided consultation regarding fingerprint clearance requirements, documentation of children's paperwork, in addition to the requirement to be present in the home at least 80% of the operating hours during the day. LPA advised that all advertisements shall include the facility number. Applicant stated that they understood.

Fire clearance requirements were discussed with Applicant during the visit.
Exit interview conducted and report was reviewed with Applicant, Wendy Xa.

LPA shall recommend approval of licensure upon receipt of a signed fire clearance.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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