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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000941
Report Date: 04/24/2023
Date Signed: 04/24/2023 04:39:18 PM

Document Has Been Signed on 04/24/2023 04:39 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:LIU, TINA A.FACILITY NUMBER:
384000941
ADMINISTRATOR:LIU, TINA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 759-5389
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
04/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Tina LiuTIME COMPLETED:
04:40 PM
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 On April 24, 2023, Licensing Program Analyst (LPA), Van, conducted an unannounced required annual inspection and met with Licensee Tina Liu. The purpose of the inspection was explained, and the Licensee granted LPA entry to the home. Today, 8 children (4 infants and 4 preschoolers) with the Licensee and a helper. The facility complies with the license capacity and limitations today. All adults living or working in the home have a criminal background clearance on file. The Licensee owns the house. The daycare is on the ground level, consisting of the playroom, nap room, kitchenette, bathroom, and backyard. The Days and operation hours are 8:30 am – 5:00 pm, Monday – Friday.
LPA inspected the Licensee's indoor and outdoor play spaces for health and safety concerns. The childcare environment is clean and organized, with age-appropriate activities, books, and play materials. The home has proper heating, lighting, and ventilation and is free of defects or situations that risk children in care. The house has a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a functional phone. The facility has a fully stocked first aid kit available for children. LPA observed no toys, pillows, or anything else hung over the infant crib. The mattress was observed to be the right size and has a fitted sheet. A child-proof cover protects every unused electrical outlet. All disinfectant and cleaning products were inaccessible to children or stored in the off-limit area. According to the Licensee, the home had no firearms, weapons, or pets. No baby walkers, bouncers, or similar equipment in the daycare. The Licensee understood that smoking is not permitted in family childcare facilities.
According to the Licensee, fire and earthquake drills are held at least once every six months. The last drill took place on April 15, 2023. The facility offers breakfast, lunch, and morning and afternoon snacks.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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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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: LIU, TINA A.
FACILITY NUMBER: 384000941
VISIT DATE: 04/24/2023
NARRATIVE
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 During the inspection, LPA reviewed all children's records. The Licensee maintains thorough records for all children in her care, including vaccination records and Parental Rights forms. LPA noted that each kid had a complete emergency information card that included the child's full name, phone number, and the location of a parent or authorized person who may be called in an emergency. The name and phone number of the child's doctor and the parent's permission for the Licensee to consent to emergency medical care. The Licensee kept up with her immunizations, Mandated Reporter Training AB 1207, and has proper daycare liability insurance. Pediatric CPR/First Aid for Licensee is valid until 4/2025. The Licensee posted all required paperwork, including the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights.
LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Licensees were informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LIU, TINA A.
FACILITY NUMBER: 384000941
VISIT DATE: 04/24/2023
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 Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.
LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
Licensee Tina Liu read and signed the report. During today's inspection, no deficiencies were discovered. Today's report and site visit notice was provided to the Licensee. LPA informed the Licensee that a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023
LIC809 (FAS) - (06/04)
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