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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001630
Report Date: 02/15/2023
Date Signed: 02/15/2023 03:22:59 PM

Document Has Been Signed on 02/15/2023 03:22 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, LAN XINGFACILITY NUMBER:
384001630
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Lan Xing LiuTIME COMPLETED:
12:15 PM
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On February 15, 2023 at approximately 10:50am, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Case Management Visit for an increase of capacity to this family child care home and met with Licensee Lan Xing Liu. Purpose of visit was explained. Present during the visit was licensee and an assistant caring for 4 children.

During today's visit, LPA and Licensee toured the home. LPA observed the home is clean orderly and properly ventilated. Telephone service, heating, lighting and ventilation were evaluated. LPA observed a 2A10BC Fire extinguisher, operable smoke detector and carbon monoxide. During today's visit, LPA also reviewed assistant's file and found to be complete.

Day Care Areas are on the 2nd level including the living room, dining room, kitchen, and bathroom. Off-limits Areas are the 2 bedrooms on the 2nd level, the entire ground level, also include the garage and the backyard.

A Fire Clearance for this family child care home was granted on 01/05/2023 by the San Francisco Fire Department with a special condition of "no occupants in lower level. Downstairs must remain an unoccupiable space."

A Large Family Child Care License is Approved and is Effective as of 02/15/2023.

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 left with Licensee whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to licensee. Licensee was advised Notice of Site Visit 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: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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