384002976-1-9-2025-05-CC-BVAN-DCS2SQ-20250109163932

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002976
Report Date: 01/09/2025
Date Signed: 01/09/2025 04:39:56 PM

Document Has Been Signed on 01/09/2025 04:39 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:	XU, CHUN		FACILITY NUMBER:	384002976
ADMINISTRATOR/ DIRECTOR:	XU, CHUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 297-2138
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 9	DATE:	01/09/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:45 PM
MET WITH:	Chun Xu		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 9, 2025, Licensing Program Analysts (LPAs) Van and Badger conducted an annual random inspection and met the Licensee, Chun Xu. LPAs explained the purpose of the inspection to the Licensee and were given access to the home. Upon entering the house, LPAs observed all the children were napping. The licensee and an assistant supervised nine children (four infants and five preschoolers). The licensee complies with the licensing capacity and limits today. All staff members present during the inspection have had their criminal record clearance verified with the CDSS Background Check System, and they are found to have eligible clearance status on file. According to the Licensee, the previously approved childcare areas were not changed. Childcare is on the second floor, including the living room, dining room, and bathroom. Off-limit areas are the entire ground floor, the backyard, the three bedrooms, and the kitchen on the second floor. All off-limits areas have been appropriately blocked off from the children. The hours of operation are Monday through Friday, 8:00 a.m. to 5:30 p.m. LPAs and the Licensee inspected the childcare areas for possible health and safety risks. The childcare areas were observed to be clean and well-organized. The fireplace was observed barricaded using shelves. The facility includes age-appropriate books and activities designed to foster learning and play for children. The home provides adequate heating, lighting, and ventilation, with no identified hazards that could endanger children. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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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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: XU, CHUN	FACILITY NUMBER: 384002976
	VISIT DATE: 01/09/2025

NARRATIVE

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The house is equipped with a combination carbon monoxide and smoke detector and a fully charged fire extinguisher, meeting a minimum specification of 2A 10 BC. Cleaning supplies and disinfectants were kept out of the children's reach. The licensee confirmed that there are no firearms or weapons in the home. LPA found no baby walkers, bouncers, or similar items in the childcare areas. The licensee was reminded that smoking is prohibited in the family childcare home.

LPAs noticed two play yards in the dining area. All play yards were observed as free of toys, blankets, or pillows. The play yard paddings fit their dimensions, and the bedsheets were snugly secured. LPAs noticed that one of the infants was napping with a sleep shack. The licensee mentioned that the family had provided the sleep shack and that the infant couldn’t sleep without it. LPAs reminded the licensee to adhere to safe sleep practices and explained that sleeping shacks are not permitted.

During the visit, all infants' sleeping logs were reviewed, and the logs were found to be complete with the 15-minute increment.

LPA discussed and informed the Licensee that she must be at home during childcare operation hours to ensure that the children in her care are always supervised. When the licensee must be absent from the house, the temporary absence should not exceed 20 percent of the hours the facility provides care per day.

During the visit, LPA reviewed the records for both children and personnel. The licensee keeps accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. The licensee and her assistants have maintained records of all essential licensing requirements, such as necessary immunizations, valid Pediatric First Aid CPR certifications, and up-to-date mandated reporter training. The Licensee has valid childcare liability insurance through Acord.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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: XU, CHUN	FACILITY NUMBER: 384002976
	VISIT DATE: 01/09/2025

NARRATIVE

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All the required licensing postings were observed posted. Based on the fire and earthquake log, the fire and earthquake drills were conducted at least once every six months, with the most recent drills completed on 9/10/2024.

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.

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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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: XU, CHUN	FACILITY NUMBER: 384002976
	VISIT DATE: 01/09/2025

NARRATIVE

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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.

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

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, Chun Xu.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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