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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002590
Report Date: 07/03/2024
Date Signed: 07/03/2024 12:48:56 PM

Document Has Been Signed on 07/03/2024 12:48 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, RAYFACILITY NUMBER:
384002590
ADMINISTRATOR/
DIRECTOR:		CHEN, RAYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 218-0632
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
07/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:SuYun Ye and Ray ChenTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On July 3, 2024., Licensing Program Analyst (LPA) Van conducted a required annual inspection and met the Licensee assistant, SuYun Ye. LPA explained the purpose of the inspection to the assistant and was given access to the home. Upon entering the house, LPA noticed an assistant supervising seven children, which did not meet the ratio required for a large family childcare license. When questioned about this, the assistant explained that another staff member was using the off-limits bathroom on the second floor. The same staff from the second floor had no records available for review except for the criminal record clearance. Another assistant and the licensee, Ray Chen, arrived during the inspection.

More children arrived during the inspection, bringing the total to 11 children (four infants and seven preschoolers).

According to the criminal records clearance verified with the CDSS Guardian background check system, it was discovered that two individuals residing at the home did not have criminal records clearance. This is a serious violation and as a result, a type A deficiency was cited, along with civil penalties.

Childcare areas are on the lower level, including the garage converted into a childcare room (living room), family room, kitchen, backyard, and bathroom. Off-limit areas are the entire upper level. All off-limits areas have been appropriately blocked off from the children. The operation hours are Monday through Friday from 8:00 a.m. to 6:00 p.m. The Licensee has valid childcare liability insurance on file.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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 07/03/2024 12:48 PM - It Cannot Be Edited


Created By: Brendon Van On 07/03/2024 at 11:24 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, RAY
FACILITY NUMBER: 384002590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above. It was found that two individuals residing at the home did not have criminal records clearance and posed an immediate health, safety, or personal rights risk to persons in care.
POC Due Date: 07/05/2024
Plan of Correction
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The Licensee must ensure that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance. The Licensee stated she would have all residents residing at the house to have complete the fingerprint process.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 07/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/03/2024 12:48 PM - It Cannot Be Edited


Created By: Brendon Van On 07/03/2024 at 11:24 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, RAY
FACILITY NUMBER: 384002590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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This requirement was not met as evidence based on observation. The Licensee did not have a carbon monoxide detector installed. Not having the Carbon monoxide detector installed at the facility poses a potential health and safety hazard to children in care.
POC Due Date: 07/12/2024
Plan of Correction
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The Licensee will install carbon monoxide alarms in the classroom by 7/12/2024. Pictures of installed carbon monoxide alarms will be submitted to Licensing for proof of correction.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, H1 did not have proof of immunization during LPA inspection. This poses a potential safety hazard to children in care.
POC Due Date: 07/12/2024
Plan of Correction
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The Center must ensure that the Director and H1's immunization records are sent to the licensing office before 7/12/2024 to verify that they have received all required immunizations. If this is not completed by the deadline, it may result in a licensing visit being required again.
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: 07/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024


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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, RAY
FACILITY NUMBER: 384002590
VISIT DATE: 07/03/2024
NARRATIVE
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LPA and the assistant inspected the childcare areas for any potential dangers to health and safety hazards. LPA observed that the childcare areas were maintained clean and orderly. The spaces had age-appropriate toys and activities to foster children's imaginative and cognitive development. The childcare areas have appropriate heating, lighting, and ventilation, and no potential hazards could endanger children in care. The Licensee had a fully charged fire extinguisher that met the minimum standards of 2A 10 BC. The facility did not have any carbon monoxide or smoke detectors. During an inspection, it was noted that two empty slots for the detectors on the ceiling were missing or had been removed. The licensee stated that he removed them last week, but the assistant claimed the owner/licensee removed them yesterday. There was no fireplace in the childcare area.

The cleaning products and disinfectants were safely stored out of children's reach. The licensee confirmed that no firearms or weapons were present on the premises. The LPA did not observe baby walkers, bouncers, or similar equipment in the childcare areas. The licensee was reminded that smoking is prohibited in the family childcare home.

The backyard is fully enclosed and equipped with age-appropriate play equipment. It is clear of any dangers or clutter that could harm the children in my care.

LPA observed that two baby cribs had loose bedsheets, although the mattresses fit their dimensions. The licensee explained that he had recently purchased two new baby cribs, which were slightly smaller than the previous ones, causing the bedsheets to be a little too big for the new cribs. The licensee and his assistant immediately removed the sheets and said they would purchase new ones to replace them.

During the inspection, logs of infants' sleeping were provided. However, it was observed that no 15-minute increment check was recorded, only the beginning and ending of the infants' sleep. Upon reviewing the logs from the previous month, it was found that the facility had documented the 15-minute increment. The Licensee and helpers were reminded to adhere to the 15-minute checks and document each check with staff initials.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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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, RAY
FACILITY NUMBER: 384002590
VISIT DATE: 07/03/2024
NARRATIVE
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Except for the staff without any record, all other staff and the licensee have records and have all the licensing requirements, including obtaining necessary immunizations and staying up to date with mandated reporter training. The licensee and the assistant hold a valid Pediatric CPR/First Aid certification.

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, with the most recent drills completed on 5/21/2024.

The records of five random children who were present were reviewed. The licensee maintains records for each child, including vaccination records, parental rights forms, and complete emergency information.

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.

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: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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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, RAY
FACILITY NUMBER: 384002590
VISIT DATE: 07/03/2024
NARRATIVE
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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.

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.

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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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, RAY
FACILITY NUMBER: 384002590
VISIT DATE: 07/03/2024
NARRATIVE
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LPA informed the Licensee to provide a copy of this licensing report dated 7/3/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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

See LIC 809D on the following page.

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, Ray Chen.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
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