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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506504
Report Date: 01/26/2024
Date Signed: 01/26/2024 01:19:19 PM

Document Has Been Signed on 01/26/2024 01:19 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:SHEN, RUN MANFACILITY NUMBER:
380506504
ADMINISTRATOR:SHEN, RUN MANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 296-8722
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94108
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
01/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Run Man ShenTIME COMPLETED:
01:45 PM
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On January 26, 20204, at approximately 12:30pm, Licensing Program Analyst (LPA) Ly conducted an Unannounced Plan of Correction (POC) Visit and met with Licensee Run Man Shen. Purpose of visit was explained. Present during the visit Licensee and an Assistant caring for 3 infants and 7 preschool age children.

The Plan of Correction (POC) Visit is regarding Type B deficiencies cited during the Required 1-Year Visit on 01/03/2024:

1. the licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

2. Assistant did not have Child Abuse Mandated Reporter Training on file

3. Assistant did not have proof of immunization record file.

During today's POC visit, LPA is able to clear the above defiencies and clear deficiencies letter were provided to Licensee:

1. LPA met with Licensee and explained the regulation required Licensee to be present and supervised children at all time. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

2. Assistant has proof of Child Abuse Mandated Reporter Training on file.

3. Assistant has proof of immunization record on file.

No deficiencies were issued today under Title 22 Division 12 of the California. Code of Regulations. A copy of this report and appeal rights were discussed and will be emailed to Director whose signature on this form confirm have read the reports. Notice of Site Visit will also be emailed. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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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