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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003074
Report Date: 02/20/2024
Date Signed: 02/20/2024 01:36:17 PM

Document Has Been Signed on 02/20/2024 01:36 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:
02/20/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Liwen ShaoTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Yee conducted a case management visit today. The facility has requested an increase in capacity. Present at the facility are the licensee, Liwen, helper, and 6 children. Current residents are licensee, Liwen, her husband, father-in-law, mother-in-law, sister-in-law, and their children ages 12 yr old, and 8 yr old. Days and hours of operations are from Monday - Friday, 8:00 a.m. - 6:00 p.m. Day-care areas: living room, front bedroom (inspected today) bathroom located in the back, and backyard. Backyard is inspected and added during the visit The remaining areas are off-limit. Licensee’s CPR, 1st is current until 6/5/2024.

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, a 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. LPA inspected the daycare areas and no visible hazards were observed.

Prior to licensure for a large FCCH, fire clearance approval is needed.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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