384002205-1-9-2024-05-CC-BVAN-CZBRFX-20240109115952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002205
Report Date: 01/09/2024
Date Signed: 01/09/2024 12:00:14 PM

Document Has Been Signed on 01/09/2024 12:00 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:	CHEN, XU MING		FACILITY NUMBER:	384002205
ADMINISTRATOR:	CHEN, XU MING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 566-8168
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	01/09/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Cai Hong Zhang and Xu Ming Chen		TIME COMPLETED:	12:30 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 9, 2024., Licensing Program Analyst (LPA) Van conducted a required inspection at the above facility. LPA rang the doorbell multiple times but received no response for about five minutes. During this time, one of the parents arrived, and an assistant opened the door. The assistant led the child inside and asked LPA to wait. After about seven to ten minutes, the Licensee, Xu Ming Chen, pulled up to the driveway. LPA explained the purpose of the inspection to the Licensee and was finally granted access to the property. The Licensee explained that the assistant was new and unaware of the Department Inspection Authority. Upon entering the facility, LPA observed two helpers supervising 12 children, 8 preschool-aged children, and 4 infants. The facility complies with the licensing capacity and limits today. All adults who live or work in the house have a criminal background check. There are no changes to the childcare areas previously approved, with the same off-limits and childcare areas. Day Care Area: the living room, children's nap room, Licensee's bedroom, the playroom, children's bathroom, the deck, and the backyard. Off-limit areas are the Licensee's children's bedrooms, the kitchen/dining area on the second floor, and the entire ground level. The days and hours of the operation are Monday – Friday from 8:00 am – 5:30 am. The Licensee has valid childcare liability insurance through Acord. LPA and the Licensee inspected the childcare areas for any potential dangers to health and safety hazards. LPA observed the childcare areas were in good condition and clean. The age-appropriate activities included imaginative, creative, and manipulative play. Moreover, the heating, lighting, and ventilation were sufficient, and no potential hazards could endanger children in care. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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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Document Has Been Signed on 01/09/2024 12:00 PM - It Cannot Be Edited

Created By: Brendon Van On 01/09/2024 at 11:22 AM

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: CHEN, XU MING	FACILITY NUMBER: 384002205
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the records review. The Licensee failed to ensure the parent completed all required licensing forms before admitting the child. Two of the children’s emergency identification forms were neither missing nor did they have parental signatures. This poses a potential Health and Safety risk to children in care.
	POC Due Date: 01/19/2024
	Plan of Correction
1 2 3 4	The Licensee shall ensure all children's files have the emergency identification form and must have a parental signature. The license will have these forms submitted to the Licensing office no later than Jan 19, 2024.

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Brendon Van

LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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: CHEN, XU MING	FACILITY NUMBER: 384002205
	VISIT DATE: 01/09/2024

NARRATIVE

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The Licensee had a fully charged fire extinguisher that met the minimum standards of 2A 10 BC and multiple combinations of carbon monoxide and smoke detectors. A functional phone was also available in case of emergencies. Cleaning agents and detergents were safely stored out of children's reach, and the Licensee confirmed that no firearms or weapons were present on the premises. The fireplace was barricaded. LPA did not observe baby walkers, bouncers, or similar equipment in the childcare areas, and the Licensee was reminded that smoking is prohibited in the family childcare home. The backyard was fenced entirely with age-appropriate playthings and was free from any hazards or debris that could potentially pose a risk to the children in care. A soft cushion is underneath the play structure to prevent accidental falls.

During the inspection, LPA reviewed and discussed the Safe Sleep Regulation with the Licensee. LPA emphasized the importance of adhering to the guidelines for cribs and playpens. The licensee was reminded that toys, blankets, or pillows should not be placed inside these sleeping areas, and no objects should be hung above them or on the sides. It was also mentioned that the mattresses must be designed specifically for cribs and playpens, and bed sheets must be tightly fitted. LPA also informed the Licensee that monitoring the infant every 15 minutes during naptime is mandatory. These checks must be documented and kept in the infant's file for review by the Department.

The licensee and helpers have maintained complete records and have met all the necessary licensing requirements, including completing required immunizations and mandated reporter training. However, one of the two assistants did not complete Pediatric First Aid training. As a Large Licensed childcare home, all staff present must possess valid CPR training. All the required posting documentation, such as the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist, have been placed in a prominent area for parents or representatives to review. According to the licensee, regular fire and earthquake drills are conducted at least once every six months. The latest drills were completed on 11/4/2023.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: CHEN, XU MING	FACILITY NUMBER: 384002205
	VISIT DATE: 01/09/2024

NARRATIVE

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Children’s records were reviewed. The licensee was found to keep records for every child, which includes details about vaccination, parental rights, and emergency contacts. However, LPA noticed that two children were without emergency identification information, or their parents had not signed the form.

During the inspection, LPA reviewed Forms/Records to Keep in Your Family Child Care Homes, children's forms/records, and personnel forms/documents with the Licensee. In addition, license capacity and limitations were also reviewed with the licensee.

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.

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.

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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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: CHEN, XU MING	FACILITY NUMBER: 384002205
	VISIT DATE: 01/09/2024

NARRATIVE

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The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

During the exit interview, the LICENSEE, XU MING CHEN, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

See LIC 809D for deficiencies cited today.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report was reviewed with the licensee, Xu Ming Chen. Today’s report, notice of site visit, and appeal rights were printed and provided to the Licensee.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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