384002676-5-21-2024-05-CC-LGOZ-D5GQ84-20240521115608

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002676
Report Date: 05/21/2024
Date Signed: 05/21/2024 11:56:24 AM

Document Has Been Signed on 05/21/2024 11:56 AM - 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:	LI, YUANCHEN		FACILITY NUMBER:	384002676
ADMINISTRATOR/ DIRECTOR:	LI, YUANCHEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 928-3373
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	05/21/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Yuanchen Li		TIME VISIT/ INSPECTION COMPLETED:	12:05 PM

NARRATIVE

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On 5/21/2024 at 9:00AM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Yuanchen Li. The purpose of today’s visit was explained and was for an unannounced, annual random Inspection. Present was the licensee and two assistants caring for 9 children. All children present were preschool-age. Licensee’s home is a two bedroom, one bathroom, one level unit. Licensee’s days and hours of operation are: Monday- Friday: 8:00AM- 5:30PM. The areas of the home designated for childcare use are the: Living room (Playroom); Dining Room (Napping Area); and Bathroom #1. The areas of the home designated as off-limits are the: Hallway (Pass through only), Bedroom #1, #2 and Kitchen Area. LPA inspected home for health and safety hazards.

At 9:15AM., the following was observed: Facility was clean, orderly with age-appropriate playthings available for the children. Floors and ground surfaces were clear of obstructions or hazards. Accessible furniture and supplies inspected were in good repair. Facility has individual cubbies are available in hallway for storage of belongings. LPA observed tables and chairs, scaled to the proper size.

For nap services, LPA observed play pens, crib and mats, stored in napping area and playroom. Infant crib had a tight-fitting sheet and mattress. Per licensee, napping supplies are washed once per week. Facility bathroom was observed clean with several potty chairs and supplies for hand washing. Diaper changing table was available for staff use. The facility was a comfortable temperature with ventilation and lighting. The off-limit areas have been made inaccessible with installed safety gates and locked doors. Home had telephone service; functioning carbon monoxide detector; smoke detector; and fire extinguisher: 3A:40BC.

At 9:35AM., LPA reviewed licensee's firearms and ammunition. LPA observed firearms are stored inside locked cabinet in the off-limit area.

LPA reminded licensee to ensure ammunition is stored and locked separately from firearms. Advisory Note: Technical Violation (LIC9102TV) was issued.

Home does not have any pools, fishponds, jacuzzi, or bodies of water. Per licensee, for outside play children are taken to local park (Noe Park).

(REFER TO 809C, FOR CONT)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

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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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: LI, YUANCHEN	FACILITY NUMBER: 384002676
	VISIT DATE: 05/21/2024

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(Page 2)
At 9:55AM., LPA reviewed facility records including the children and staff files. The children’s files were reviewed and included the: Notification of Parent’s Rights (LIC995); Consent for Medical Treatment (LIC627) Identification and Emergency Information (LIC700); Affidavit Regarding Liability Insurance (LIC282); and Immunization Record.

The staff files were reviewed and included the: Notice of Employee Rights (LIC9052); ‘Mandated Reporter Training’ (AB1207); Acknowledgement to Report Suspected Child Abuse (LIC9108); and Proof of Immunization.

Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 6/2024.
Licensee’s ‘Mandated Reporter Training’ was current, expiring: 6/3/2025.

LPA reminded licensee to document each disaster drill conducted in facility. Advisory Note: Technical Violation (LIC9102TV) was issued.

The required forms are posted in hallway including the: Facility License; Notification of Parent’s Rights (PUB379); and the Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill child is in the playroom. Per licensee, she provides food service for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

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

FACILITY NAME: LI, YUANCHEN	FACILITY NUMBER: 384002676
	VISIT DATE: 05/21/2024

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(Page 3)
Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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 the Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://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 of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations. Exit interview and report was reviewed with Licensee, Yuanchen Li. Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, Licensee, Yuanchen Li confirmed no registered sex offenders are living in the facility and LPA completed RSO profile. Notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

LIC809 (FAS) - (06/04)

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