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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505039
Report Date: 04/11/2024
Date Signed: 04/11/2024 04:28:12 PM

Document Has Been Signed on 04/11/2024 04:28 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CCFC-30TH AVENUEFACILITY NUMBER:
380505039
ADMINISTRATOR/
DIRECTOR:
SEAN OWENSFACILITY TYPE:
850
ADDRESS:741 30TH AVENUETELEPHONE:
(415) 668-6539
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 29TOTAL ENROLLED CHILDREN: 13CENSUS: 7DATE:
04/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Yan Hui LiuTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today, LPA met with the Site Director/Center Manager, Yan Hui Liu, and 2 staff. LPA explained the purpose of the inspection to her. All adults have fingerprint clearance. The Site Director stayed the total enrolled is 13 children. The facility had 7 children with 2 staff and a Site Director present upon LPA's arrival. The facility operation hours are Monday to Friday from 7:30 AM to 5:30 PM. LPA inspected the facility for health and safety hazards. The facility was clean and in order, the temperature and lighting were adequate, and toxins and harmful objects were made inaccessible to the children. The facility has a total of two connected classrooms, a front lobby with an adjacent food preparation area, a bathroom with 2 toilets and a big sink with 2 faucets, a diaper changing room with a diaper changing table with 1 arm reach big sink and 1 small sink, a food preparation area and the office on this site. The facility has separate staff bathrooms available for staff. The children's bathroom was clean and free of harmful objects. All lower cabinets in the front lobby and food preparation area were latched. The food waste trash can had a tight lid. The facility installed gates at the entrance of the bathroom, diaper changing room, and the entrance to the main classroom. The classrooms were clean, safe, and set up with age-appropriate toys, books, learning material & equipment, and children's furniture that were in good condition and repaired. The facility provides breakfast, lunch, and PM snacks to children from the central kitchen that is located at the center of CCFC 31st Avenue. Drinking water was served in water pitchers with paper cups. There was a small fish tank with a tight lid in the classroom. All electrical outlets were covered. First aid supplies were available for children in the classroom. Cots were used for napping. The facility provides bedding that is washed by the facility weekly for each child. Emergency supplies were available at the Facility. Sick children will be separated from the group and placed in the office while waiting for their parents to pick up. The facility has its outdoor play area at the property. The outdoor play yards were completely fenced. The facility shared the usage of a play yard with another CCFC facility (CCFC 31st Avenue) across the building. The Outdoor play yards had age-appropriate toys, play structures, slide structures, climbing structures, and sandboxes available for children. The facility installed soft cushioning on the entire ground to prevent injury. Per the Site Director, there were no children on special medication. The facility posted the required forms (i.e. License, snack menus, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). The facility conducts the disaster drill monthly and properly logs. LPA inspected the sign in/out during the inspection. All staff has current CPR and First Aid training, which will expire in 10/2025, and Child Abuse Mandated Reporter Training. LPA also reviewed the children's and staff's files and obtained a copy of the current children's roster during the inspection. The facility passed the Lead Water Test on 12/17/2022.

continues in LIC 809C.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CCFC-30TH AVENUE
FACILITY NUMBER: 380505039
VISIT DATE: 04/11/2024
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Criminal Record Clearance - Licensee was reminded that all adults 18 and over living or working in 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 22-02CCP. 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/.

MyChildCarePlan.org – 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.


Notice of Site Visit - A notice of site visit was given and must remain posted for 30 days.

Exit Interview - Exit interview conducted and report was reviewed with the licensee, Yan Hui Liu.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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