384001657-1-9-2025-05-CC-KKRN-DCS3YF-20250109173953

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001657
Report Date: 01/09/2025
Date Signed: 01/09/2025 05:40:06 PM

Document Has Been Signed on 01/09/2025 05:40 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	LEE, HELEN		FACILITY NUMBER:	384001657
ADMINISTRATOR/ DIRECTOR:	LEE, HELEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 632-7873
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 5	CENSUS: 5	DATE:	01/09/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:46 PM
MET WITH:	Helen Lee		TIME VISIT/ INSPECTION COMPLETED:	05:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 09, 2025 at approximately 3:15pm, Licensing Program Analysts (LPAs) Tso and Krenn conducted an unannounced required annual visit to the Family Child Care Home listed above. The LPA was granted entry by the Licensee, Helen Lee. LPAs explained the purpose of the visit. Present during LPAs’ visit included licensee, and 5 enrolled children (1 infant and 4 preschool age). The licensee is operating within capacity limits and ratio during LPAs’ visit. Licensee owned and lived in a 2 stories single-family house. Adults living in the home have criminal record clearance on file. The hours of operation are Monday through Friday 9:00am to 4:30pm. The DAY CARE AREAS are on the ground level including, a large playroom, a bathroom, and a backyard. Per the licensee, she closed the backyard for the daycare temporarily. The licensee has taken the children to the public park nearby instead. LPAs observed the door access to backyard was closed. The OFF LIMIT AREAS are the entire second floor and the storage area, the front office on the ground floor, and a garage. Off-limit areas are properly barricaded with child safety gates and/or closed doors. The LPAs and the licensee both performed inspection of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The facility has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a smoke detector, and a carbon monoxide detector (tested under working conditions during the visit), and a 3A40BC fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPAs did not find any walkers, bouncers, or other comparable objects during today’s inspection. According to the licensee, there are reportedly no firearms or other weapons on the premises. The LPAs found that the facility did not have any bodies of water. (Continued Report on Page 2...)

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Katie Krenn
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LEE, HELEN	FACILITY NUMBER: 384001657
	VISIT DATE: 01/09/2025

NARRATIVE

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The LPAs observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The Licensee is aware that smoking is not permitted in a family childcare facility.

Bathroom for children's use was observed to be in proper working condition. LPAs did not observe any hazardous materials to be accessible to children.

LPAs reviewed five children’s records. Children’s files have a record of emergency identification information on file. Two of the five children’s records did not have immunization records. At the time of the visit licensee was unable to provide a current CPR/First Aid (refer to LIC809D) and Mandated Report certificate. LPAs reminded the licensee to conduct the emergency drills and keep the log by 1/23/2025. Licensee has licensing documentation properly posted and available for review.

LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training.

Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
(Continued Report on Page 3...)

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Katie Krenn
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LEE, HELEN	FACILITY NUMBER: 384001657
	VISIT DATE: 01/09/2025

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the 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.

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 22-02-CCP. 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/.

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.

During the exit interview, the licensee, Helen Lee, confirmed that there are no Registered Sex Offenders living in the facility.

Please refer to LIC 809D for today’s citation. A copy of today’s report and the facility’s appeal rights were discussed and given to the licensee. The Notice of Site Visit was given to the licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the licensee, Helen Lee.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Katie Krenn
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

Page: 3 of 7

Document Has Been Signed on 01/09/2025 05:40 PM - It Cannot Be Edited

Created By: Katie Krenn On 01/09/2025 at 05:05 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LEE, HELEN	FACILITY NUMBER: 384001657
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in that no current CPR and First Aid certificate was found, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2025
	Plan of Correction
1 2 3 4	Licensee will send current CPR and First Aid certificate to the lincesing office by 01/23/2025

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Daniel J Oquendo

LICENSING EVALUATOR NAME:

Katie Krenn

LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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