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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002976
Report Date: 01/18/2024
Date Signed: 01/18/2024 04:06:18 PM

Document Has Been Signed on 01/18/2024 04:06 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:XU, CHUNFACILITY NUMBER:
384002976
ADMINISTRATOR:XU, CHUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 297-2138
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Chun Xu TIME COMPLETED:
04:30 PM
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On January 18, 2024, at 01:00 PM, Licensing Program Analyst (LPAs) Gil and Van arrived at the home facility to conduct an unannounced Annual Inspection. LPAs met with Xu Chun. The purpose of the inspection was explained. There were 6 children present in the home during nap time (2 infants and 4 preschoolers). LPAs verified the background check clearance of the adults working or living in the home. The hours of operation are Monday through Friday, 08:00 AM- 5:30 PM. Licensee provides AM snacks, lunch, and PM snacks, which are all prepped and served at the facility. The Licensee stated there are no changes to the physical plant, and all childcare areas remain the same.

Day-care areas: Living room, dining room, and bathroom.

Off Limit areas: Entire ground floor, back yard, the three bedrooms, and the kitchen on the second floor

LPAs observed that off limit areas were properly barricaded and made inaccessible to the children in care.

LPAs and Licensee inspected the entire childcare area for Health and Safety hazards. There are multiple carbon monoxide and smoke detectors located in each room. One fully charged fire extinguisher of size 2A10BC was also available in the home, located in the kitchen. First Aid kit is fully stocked and accessible, located in the dining room. Licensee states, there are no pools, weapons, or guns in the home. LPAs did not observe any walkers, bouncers, or similar items in the home.

LPAs observed that the house is in good repair and free of hazards with proper temperature and ventilation and lighting. The play area is clean, padded/carpeted and in good condition. LPAs observed that there are a variety of age-appropriate toys, books, and other learning materials available in the home. There are small tables and kitchen play sets in the home. Electric outlets have proper covers, and a working phone is on site. The Licensee has valid liability insurance available on file. LPAs observed that the day care area has multiple coloring materials such as paint, crayons and markers organized in a corner.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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: XU, CHUN
FACILITY NUMBER: 384002976
VISIT DATE: 01/18/2024
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All posting requirements are met and posted near the childcare entrance. The licensee has valid CPR and First Aid card expiring on 6/2024. Mandated reporter training certificate is valid and expiring on 10/15/2024. LPAs reviewed facility records. The facility conducts fire and earthquake drills with the children at least once every six months. The most recent one was on 9/1/23.

LPAs reviewed all the children's records during the inspection. The Licensee maintains thorough records for all children, including vaccination records and Parent's Rights forms. LPAs confirmed that each child has proper emergency information with the child's full name, phone number, and contact information for a parent or authorized person who may be called in an emergency. Licensee does have a new infant that started on 1/8/2024. Infant was missing 9224. LPAs reminded licensee that this form must be signed for new child in care immediately or Type A would be issued. Licensee agreed to send it within the next day via email to LPAs. License has only one day of sleep logged for her new infant in her childcare. The second infant is part time and is usually picked up by parent before nap time, (he only has some days logged). LPAs left a technical violation for licensee and reminded her to fill out sleeping logs daily for her two infants in care and any future infants in her care. LPAs observed two kids in booster constrained for more than 15 minutes. Licensee claimed this was because she was assisting us. LPAs recommends she finds a helper or support staff.

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.

Per Licensee, there are no children enrolled with allergies. Incidental Medical Services (IMS) policy was discussed. For IMS information 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: on 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 www.ada.gov/childqanda.htm.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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: XU, CHUN
FACILITY NUMBER: 384002976
VISIT DATE: 01/18/2024
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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.

LPAs 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.

LPAs encouraged the Licensee to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

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, Chun Xu, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile on FAS.

LPAs 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-and-resources/safe-sleep as an additional resource.

LPAs also informed 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.

The report was reviewed and signed by Licensee Chun Xu. No deficiencies were observed or cited today. Today's report and Site visit notice were provided to the Licensee. LPAs informed the Licensee that a site visit notice must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Chun Xu.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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