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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002205
Report Date: 02/10/2025
Date Signed: 02/10/2025 03:03:55 PM

Document Has Been Signed on 02/10/2025 03:03 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:CHEN, XU MINGFACILITY NUMBER:
384002205
ADMINISTRATOR/
DIRECTOR:		CHEN, XU MINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 566-8168
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
02/10/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:ChuTong TangTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On February 10, 2025, Licensing Program Analysts (LPAs) Naves and Van conducted an unannounced Plan of Correction (POC) and met with the Licensee’s assistant, ChuTong Tang. The licensee was not home upon LPAs arrival. According to the assistant, the licensee has a doctor's appointment today. When asked what time licensee left assistant said she left at noon. Licensee arrived around 2:13pm and stated she had gone to Kaiser to try and be seen as a walk in and decided just to come back, when asked what time she left licensee stated 1:30pm. The purpose of the inspection was explained, and access to the facility was granted by assistant ChuTong Tang. Upon entering the facility, LPAs observed the children were napping. At the time of the inspection, the Licensee and two assistants supervised 10 children.

A type A deficiency was identified and documented during the annual inspection on January 23, 2025. It was noted that on that day, 2 out of 4 infants were swaddled while they napped. One of the sleeping infants also had a blanket, pillow, and books inside the crib. Moreover, blankets had been used to cover the mattresses, with their edges folded upward.

During today’s inspection, LPAs thoroughly examined the childcare areas, particularly the two infant napping areas. LPAs found all cribs were clear of blankets, toys, or pillows. Each crib was equipped with tightly fitted sheets and suitable mattresses. No children were napping in cribs today. The deficiency cited during the January 23, 2025 inspection has been cleared as of 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.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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