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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003074
Report Date: 05/11/2023
Date Signed: 05/11/2023 03:24:15 PM

Document Has Been Signed on 05/11/2023 03:24 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:SHAO, LIWENFACILITY NUMBER:
384003074
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
05/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Liwen ShaoTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Yee conducted an unannounced Annual Inspection and met with Licensee, Liwen Shao, and 6 children. The purpose of the inspection was explained. Current residents are licensee, Liwen, her husband, father-in-law, mother-in-law, sister-in-law and their children ages 11 yr old, 8 yr old. The facility personnel summary report was reviewed with Liwen during the inspection and updated. Days and hours of operations are from Monday - Friday, 8:00 a.m. - 6:00 p.m. Day-care areas: living room, bathroom located in the back, and the deck. The remaining areas are off-limit.

LPA observed the following: The daycare area is equipped with age-appropriate toys and equipment for the children. The home has sufficient lighting and ventilation. The home has a working telephone, working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There are no bodies of water on the property. There are no poisons, detergents, or cleaning products accessible to daycare children. Fire drills are conducted monthly. Licensee’s CPR, 1st is current until 6/5/2024. Licensee provides daily snacks and meals.

LPA reviewed Children roster. Licensee has all required postings posted for parents to review.

*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualify for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website.
*Licensee was reminded about Mandated Reporter Training available on the CCLD website www.ccld.ca.gov or www.mandatedreporterca.com).
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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: SHAO, LIWEN
FACILITY NUMBER: 384003074
VISIT DATE: 05/11/2023
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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: http://www.ada.gov/childqanda.htm

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.

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

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.


>This report and rights to comment and appeal were discussed with Licensee. This report is translated into Spanish via Google translation. This report must be available in the facility for public review. A notice of site visit was given and must remain posted for 30 days.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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