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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002590
Report Date: 05/05/2026
Date Signed: 05/05/2026 04:20:01 PM

Document Has Been Signed on 05/05/2026 04:20 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, RAYFACILITY NUMBER:
384002590
ADMINISTRATOR/
DIRECTOR:		CHEN, RAYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 218-0632
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
05/05/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:H1 & Ray ChenTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On May 5, 2026 at approximately 12:20pm, Licensing Program Analysts (LPAs) Quimbo and Leong conducted an unannounced, annual inspection. LPAs met with helper 1 (H1) and explained the purpose of the visit. LPAs were granted entry to the family childcare home by H1.

Upon LPAs' arrival, licensee, Ray Chen, was not present. H1 stated they will contact licensee to inform licensee of LPAs' presence. Present during LPAs' visit included H1, helper 2 (H2), and 5 children (4 preschool age and 1 infant). LPAs observed assistants present to have fingerprint clearance and association to facility number. LPAs also observed assistants present to have a current Pediatric CPR and First Aid certification.

Hours of operation are Monday through Friday 7:30am to 6:00pm. With H1, LPAs inspected day care areas. The home is a multi-level home with a second level and ground level. Per H1, children utilize the ground level of the home only.

The DAY CARE AREAS are the garage (converted into one, large childcare room), kitchenette, bathroom in the garage, and backyard. The OFF LIMIT AREAS are the office room (pass by to the backyard) and entire second level of the home. There are closed doors that lead to off limit areas.

LPAs observed day care area to have a variety of toys and materials. Per H1, toys and materials are cleaned weekly. Flooring in childcare room includes carpet. Per H1, carpet is vacuumed at least twice a week. LPAs observed carpet to be free of stains. There are poles in the childcare room that are padded. LPAs advised for additional padding on poles. There is a kitchenette in the childcare room that is made inaccessible with a gate. LPAs observed knives to be stored in a high shelf. LPAs also observed drawers and cabinets in childcare room to have child safety locks installed. LPAs observed poisons, cleaning solutions to be made inaccessible behind child safety locked cabinets and/or in home's high shelves.
(Continue report on page 2...)
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/05/2026 04:20 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 05/05/2026 at 02:35 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: CHEN, RAY
FACILITY NUMBER: 384002590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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. LPAs observed H1 and H2 to have completed Mandated Reporter certifications, however, certifications were missing child care training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2026
Plan of Correction
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LPAs reminded licensee staff working with children must have Mandated Reporter training certifications that include child care training (AB1207). Licensee stated staff will complete the missing portion of training by POC due date. LPAs to conduct a follow up visit.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

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. Licensee stated second level of the home, an off limit area, is utilized for childcare services, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
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Licensee will make second level of home inaccessible to children. Licensee stated they will barricade stairs leading to second level of home. LPAs to conduct a follow up visit to verify second level of home is made inaccessible.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/05/2026 04:20 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 05/05/2026 at 02:35 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: CHEN, RAY
FACILITY NUMBER: 384002590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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, the licensee did not comply with the section cited above. H2 was observed to be working with children during today's visit. LPAs did not observe H2 to have proof of their required immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2026
Plan of Correction
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Licensee stated they will obtain H2's immunization records by POC due date. LPAs to conduct a follow up visit.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

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. Two of five children present were observed to be missing immunization records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2026
Plan of Correction
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Licensee stated they will obtain the missing immunization records for the children by POC due date. LPAs to conduct a follow up visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/05/2026 04:20 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 05/05/2026 at 02:35 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: CHEN, RAY
FACILITY NUMBER: 384002590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at 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. There is an enrolled infant under 12 months of age enrolled in program and present during today's visit, without a completed LIC9227, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2026
Plan of Correction
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Licensee stated they will have infant's family complete an LIC9227 that will be made availabel for LPA's review by POC due date.
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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 5 of 9
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: CHEN, RAY
FACILITY NUMBER: 384002590
VISIT DATE: 05/05/2026
NARRATIVE
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(Continued, Page 2...)
There is a child's toilet and sink in the childcare room (separate restroom for adult use). LPAs observed toilet and sink to be in working condition. There is a diaper changing area in the childcare room. Per H1, children's families provide diapers and wipes for diapering children. LPAs observed a garbage bin with a tight fitting lid in the childcare room to dispose of dirty diapers.

Children sleep in the childcare room. Preschool age children sleep on children's sofa/floor mat beds while infants sleep in cribs. LPAs observed an infant sleeping in a crib that was free of loose articles, objects and materials. Sleeping logs are maintained for napping infants that were made available for review. LPA observed sleeping logs to document the initial time the infant falls asleep, the 15 minute time stamp of when the infant wakes up and any marks for signs of distress. LPA reviewed random sleeping logs from May 2023, July 2025, September 2025, and April 2026.

Home is equipped with a smoke and carbon monoxide detector. LPAs tested detectors during visit, which were observed to be working. Home is also equipped with a fully charged fire extinguisher and first aid kits. A food service is provided to children. Per H1, no children enrolled currently have any allergies.

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/

At approximately 1:30pm, Licensee, Ray Chen, arrived to facility. LPAs continued visit with licensee.

Backyard is fully enclosed and fenced. Backyard includes a variety of outdoor toys and equipment that are in good condition. Flooring in backyard includes rubber padding. LPAs observed accessible, loose debris and materials in backyard that included a ladder, wooden planks, electrical wires, shovels, gardening materials with rust and loose sprinkler pipe. LPAs observed exit routes to be hindered with additional materials. LPAs advised licensee to remove and/or make hazardous materials inaccessible to children. LPAs also advised licensee to make exit route/path clear. Licensee stated they will create a barrier to where hazardous materials will be stored and will clean exit route. A Type B deficiency was issued for loose debris and accessible, hazardous materials. LPAs did not observe any pools, spas or bodies of water on site.
(Continue report on page 3...)
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC809 (FAS) - (06/04)
Page: 6 of 9
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: CHEN, RAY
FACILITY NUMBER: 384002590
VISIT DATE: 05/05/2026
NARRATIVE
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(Continued, Page 3...)
Per licensee, isolation area is located on the second level of the home. LPAs requested to inspect isolation area. LPAs observed living room on second level of home to be equipped with a variety of children's toys and materials. Per licensee, enrolled children utilize second level of the home as needed for sleeping and for play activities. LPAs reminded licensee second level of home is off limits to children. A Type B deficiency was issued for use of an off limit area.

LPAs reviewed facility's records that included children's, licensee, H1 and H2's records. Emergency disaster drills are conducted at least once every six months and are documented. Last documented drill was conducted 4/20/2026.

LPAs observed an infant under 12 months of age to be enrolled in home, however, to be missing a completed Individual Infant Sleeping Plan form (LIC9227). LPAs reminded licensee LIC9227 must be maintained for all enrolled infants under 12 months. A Type B deficiency was issued.

LPA observed two of the five children present to be missing immunization records. LPAs discussed children's immunization records must be made available for review. A Type B deficiency was issued. LPAs observed licensee's Pediatric CPR and First Aid certificate is current and will expire 4/2027. Licensee's Mandated Reporter certificate is also current and will expire 3/2028. LPAs observed licensee's Mandated Reporter certificate to include AB1207 certification.

LPAs observed H1 and H2 to have current Pediatric CPR and First Aid certifications. LPAs observed H1 and H2's Mandated Reporter certifications to also be current, however, do not include AB1207 certification. LPAs reminded licensee all staff working with children must have a Mandated Reporter certificate that includes AB1207 certification. A Type B deficiency was issued.

LPAs also observed H1 to have proof of their required immunizations, available for review. LPAs observed H2 to not have proof of their immunizations available for review. LPAs observed H2 to be working directly with children during today's visit. LPAs reminded licensee all staff working with children must have proof of their required immunizations, available for review. A Type B deficiency was issued.

Two tenants live in the second level of the home. LPAs observed tenants to have fingerprint clearance on file. Licensing documents are posted in the main day care area, available for review. A childcare roster was made available for review. Licensee maintains liability insurance that was also made available for review.

(Continue report on page 4...)
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: CHEN, RAY
FACILITY NUMBER: 384002590
VISIT DATE: 05/05/2026
NARRATIVE
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(Continued, Page 4...)
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 and removing any 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 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.

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 Ray Chen confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

During today's visit, Type B deficiencies were issued for loose debris, missing immunization records for two children present, missing LIC9227 for an infant present, missing immunization record for H2, missing AB1207 certifications for H1 and H2, and use of an off limit area. Plan of corrections were discussed. Appeal rights were provided.

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

Exit interview conducted and report was reviewed with the licensee, Ray Chen.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 05/05/2026 04:20 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 05/05/2026 at 03:12 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: CHEN, RAY
FACILITY NUMBER: 384002590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

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. LPAs observed backyard to have accessible shovels, wooden planks, electrical wires, shovels, gardening materials with rust and loose sprinkler pipe, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2026
Plan of Correction
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Licensee stated they will make hazardous materials inaccessible to children. LPAs to conduct a follow up visit.
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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
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