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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003053
Report Date: 07/24/2024
Date Signed: 07/24/2024 05:59:56 PM

Document Has Been Signed on 07/24/2024 05:59 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:KIYASU, EMILYFACILITY NUMBER:
384003053
ADMINISTRATOR/
DIRECTOR:		KIYASU, EMILYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 370-7010
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
07/24/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:28 PM
MET WITH:Emily KiyasuTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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On July 24, 2024, Licensing Program Analysts (LPAs) Basak and Garcia conducted an announced annual inspection and met the Licensee, Emily Kiyasu. LPAs explained to the Licensee the purpose of the inspection.

LPAs observed the licensee and the 3 helpers supervising 10 children (2 infant and 8 preschool-age). The licensee complies with the licensing capacity. The children's roster has been reviewed on Brightwheel application and found to be complete and up to date.


All present adult have their criminal background clearance and LPAs associated three helper to facility on Guardian website.
Daycare areas: Living room, hallway bathroom, Foyer, front yard, and backyard. The hallway from the Foyer to the backdoor will be used as the pathway to the backyard only. Off Limit areas: Entire 1st floor, 3rd floor, and 4th floor; garage, and pantry and kitchen on the 2nd floor. According to the licensee, there are no changes to the previously approved childcare and off-limit areas.
LPAs observed all off limit areas inaccessible to children.
LPAs observed the home to be clean and in good repair with proper temperature and ventilation. There are working smoke detector and carbon monoxide detector, and a fully charged fire extinguisher in size of 2A10BC. The childcare home has a functioning telephone. Per the Licensee, there are no firearms, guns, or weapons in the home. The Licensee stated they provide breakfast, lunch, a.m and p.m snack alongside drinking water.
See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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: KIYASU, EMILY
FACILITY NUMBER: 384003053
VISIT DATE: 07/24/2024
NARRATIVE
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Page 2.
The operation hours of Child Care Home are Monday to Friday from 8:00 am to 5:30 pm.
LPAs and the Licensee inspected the childcare areas for health and safety hazards. The childcare area is clean and free from hazards. LPAs observed all cleaning supplies, and other chemicals are stored properly and inaccessible to children.
LPAs observed a daycare area is equipped with age-appropriate furniture, toys, books, and educational materials.

Mats and individual sheets were observed in the napping area. LPAs confirmed with the licensee they have an isolation area for ill children to wait until their parents arrive.
No toys or pillows inside and no objects hanging above the crib were observed. LPAs discussed with the Licensee that all mattresses should be designed for the cribs and bedsheets should be tightly fitted. In addition, the Licensee was informed about the sleep log, to check the infant every 15 minutes during naptime.
The Licensee understood that no baby walkers, bouncers, or other similar items are permissible to be used during daycare hours.

LPAs observed the licensee does not have a valid CPR & First Aid and Mandated Reporter Training and the helpers have valid CPR certifications. Per the Licensee, the fire and earthquake drills are conducted at least every six months, and the latest drill was conducted on July 22, 2024

The licensee not able to provide some of the children and staff records to the LPAs including Emergency cards, Admission agreement, Parent's right.
LPAs observed some postings are missing in daycare home, including Parent's Rights poster, and Earthquake Preparedness Checklist.
See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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: KIYASU, EMILY
FACILITY NUMBER: 384003053
VISIT DATE: 07/24/2024
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Page 3
The licensee stated there are two children present has allergy. LPAs observed no bodies of water in the premises.
The 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.
LPAs discussed the safe sleep regulations with the licensee 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.

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.

See page 4.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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: KIYASU, EMILY
FACILITY NUMBER: 384003053
VISIT DATE: 07/24/2024
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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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families find childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Emily Kiyasu confirmed that there are no Registered Sex Offenders living in the facility, and LPAs 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 and appeal rights were reviewed with the licensee, Emily Kiyasu. Today's report will be emailed to the licensee due to printer malfunction. Verification of reports being received is required.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/24/2024 05:59 PM - It Cannot Be Edited


Created By: Zeynep Basak On 07/24/2024 at 05:36 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: KIYASU, EMILY
FACILITY NUMBER: 384003053

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024

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) (record review)], the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/26/2024
Plan of Correction
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They will complete all the training. They will check each child file and have all required documents completed sooner. They will make sure to complete all required documentation.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above inwhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/26/2024
Plan of Correction
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They will make sure all children, staff completed their immunizations
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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
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