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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001201
Report Date: 06/25/2024
Date Signed: 06/25/2024 04:25:36 PM

Document Has Been Signed on 06/25/2024 04:25 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:CUI, PEI XIANFACILITY NUMBER:
384001201
ADMINISTRATOR/
DIRECTOR:		CUI, PEI XIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 468-8918
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY: 14; 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
06/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Pei Xian Cui (Patty)TIME 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 licensee, Pei Xian Cui (Patty), her husband (a helper) and her daughter. All adults have fingerprint clearance. LPA explained the purpose of the inspection to them. LPA observed 10 children including two infants and 8 preschoolers with a helper and the licensee present. The children were napping upon LPA's arrival. The licensee owns and lives with her husband, and her daughter in this 2-level single-family house. The licensee's daughter and son visit them sometimes during the years. The facility is called KV Child Care, and the operation hours are Monday to Friday from 8 AM to 6 PM. The daycare areas are a living room that is used as the main playroom, a bedroom next to the stairway is used for children's activities such as napping, a dining room, a hallway bathroom, and a children's bathroom that is next to the dining room & a patio that is behind the kitchen. The kitchen is used as a pathway when children access the patio and the backyard. The off-limit areas are the Licensee's bedroom, the licensee’s daughter's bedroom, & entire lower level. (Per the licensee, the backyard is temporarily closed because she wants to set up the backyard for the daycare children). LPA inspected the facility for health and safety hazards. The facility was clean and in order, temperature and lighting were adequate, and toxin items were made inaccessible to the children. The licensee installed a gate at the stairway and the entrance of the dining room to prevent children from accessing the off-limit areas. There was a fully charged 2A10BC fire extinguisher, a working landline phone and cellular phone, and first aid supplies available in the house. LPA did not test the smoke and carbon monoxide detector due to napping during the inspection. The facility has a fire sprinkler system installed in the house. All sharp corners and electrical outlets were covered. Window locks were installed on the windows in the living room. There was a turtle in a mid-size fish tank with a tight lid in the living room. Children’s bathrooms were clean and free of harmful objects. A children's bathroom had the right size of toilets available for daycare children. Playpens and cots were used for napping. The carpet was installed on the entire floor as the soft cushioning to prevent injury. The deck was completely fenced. Gates were installed at the stairway to the backyard. LPA didn’t observe any harmful objects there. The licensee provides breakfast, AM/PM snacks, lunch, and dinner to the daycare children. The licensee has guns that were stored in a Gun Safe that is located in the off-limit area. The licensee stores the ammunition in a separate area from the guns. The licensee and her helper had current CPR/First Aid training that will expire on 8/7/2024. The licensee and her husband had updated Child Abuse Mandated Reporter Training that will expire on 2/18/2025. The disaster drill has been conducted 2 times a year and logged. The latest drill was conducted on 4/2024. The facility has bought childcare insurance that will expire on 5/2025. Per the licensee, there were no children on special medication. LPA reviewed the children's file and obtained a copy of the children's roster from the licensee. LPA inspected the 15-minute check nap log during the inspection. All postings were posted.

continues in LIC809C
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: CUI, PEI XIAN
FACILITY NUMBER: 384001201
VISIT DATE: 06/25/2024
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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.

Safe Sleep - 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 22-02CCP. 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/.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CUI, PEI XIAN
FACILITY NUMBER: 384001201
VISIT DATE: 06/25/2024
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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.

Megan’s Law - During the exit interview, Cui, Pei Xian (Patty), confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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, Cui, Pei Xian (Patty).
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
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