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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004049
Report Date: 09/27/2023
Date Signed: 09/27/2023 06:35:00 PM

Document Has Been Signed on 09/27/2023 06:35 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:LI, YUTINGFACILITY NUMBER:
384004049
ADMINISTRATOR:LI, YUTINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 910-7683
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Li YutingTIME COMPLETED:
06:45 PM
NARRATIVE
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On September 27, 2023 at approximately 1:45pm, Licensing Program Analysts (LPAs) Man Tso and Brendon Van conducted an unannounced, annual inspection. LPA met with licensee, Yuting Li, and explained the purpose of the visit.

Licensee stated they live on the first floor of the multi-level home with their mother. Per licensee, there are no weapons or firearms in the home. Hours of operation are Monday to Friday 7.30am to 5:30pm. Present during LPAs' visit included 8 children (3 infant and 5 preschool age). Licensee provided lunch and PM snack to the children.

Day Care Areas (First floor only): Living room, kitchen, bathroom, and backyard. Off Limit Areas: First floor: Bedroom #1, bedroom #2. Off limit areas are made inaccessible with locked doors.

With licensee, LPAs toured day care areas of home. LPAs observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPAs observed electrical outlets to be made inaccessible with child safety covers. Home is equipped with a fully charged fire extinguisher and a dual smoke/carbon monoxide detector. During visit, LPA tested detector which was observed to be working. LPA observed kitchen cabinets to have child safety locks installed. However, LPAs observed that a kitchen cabinet is not locked with a bottle of bleach there. LPAs reminded the licensee to lock immediately. The licensee was reminded any cleaning products, sharp device, such as knife should be installed child proof locked. The licensee was also reminded to install the child proof lock on the stove’s switches. The licensee agreed to install in this week.

Flooring in living room flooring includes padding that was observed to be clean. There is a no fireplace in the living room. LPAs observed bathroom cabinets and drawers to have child safety locks installed. LPAs did not observe any further poisons, chemicals or hazardous materials to be accessible.

Napping area was observed to be clean and properly ventilated. Flooring also includes additional padding that was observed to be clean. LPAs observed napping area to include cribs for napping children. LPAs observed cribs to be free of any loose articles or materials. But LPAs observe the cribs to have blankets. Licensee was reminded to remove the blanket immediately and was explained the safe sleep requirement Licensee did not provide the updated 15-minute sleeping check log for review. LPAs reminded licensee sleeping logs must be maintained for all infants under 24 months and must document the 15-minute time check of when napping infants were last checked on.
(Continue Report on Page 2...)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
Document Has Been Signed on 09/27/2023 06:35 PM - It Cannot Be Edited


Created By: Man Tso On 09/27/2023 at 04:46 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: LI, YUTING
FACILITY NUMBER: 384004049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interviews, and record review, the helper is an uncleared individual directly working with supervising enrolled children. This poses an immediate Health and Safety risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
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The Licensee must ensure that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance. The Licensee states she will have the helper/mother complete the fingerprint process before the helper can return to the facility and work/or live at home. In the meantime, while waiting for the fingerprint to clear, the helper/sister-in-law will be staying with a relative.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ali Zebila
LICENSING EVALUATOR NAME:Man Tso
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 09/27/2023 06:35 PM - It Cannot Be Edited


Created By: Man Tso On 09/27/2023 at 04:46 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: LI, YUTING
FACILITY NUMBER: 384004049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview with the licensee, the licensee did not have proof that the drills are being conducted and documented at least once every six months. No conducting drills could present potential health and safety risk to persons in care.

POC Due Date: 10/13/2023
Plan of Correction
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The licensee will conduct a fire or earthquake drill, create a plan for completing documenting completed drills, and plan a future drill for six months from the first drill. This plan and proof of the first completed drill are due and submitted to the Department by October 13, 2023

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:Ali Zebila
LICENSING EVALUATOR NAME:Man Tso
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/27/2023 06:35 PM - It Cannot Be Edited


Created By: Man Tso On 09/27/2023 at 04:46 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: LI, YUTING
FACILITY NUMBER: 384004049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not provide the immunization record of the children for review, which poses a potential health and safety risk to persons in care.
POC Due Date: 10/13/2023
Plan of Correction
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Licensee must ensure that all children immunization records are filed and available for review. The licensee states she will have her immunization records submitted to LPA on or before October 13, 2023
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ali Zebila
LICENSING EVALUATOR NAME:Man Tso
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


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: LI, YUTING
FACILITY NUMBER: 384004049
VISIT DATE: 09/27/2023
NARRATIVE
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LPAs reviewed 8 children's records, whom were present during LPAs' visit. Licensee cannot maintain the complete children in care record. Some children’s records missing parents’ signatures. Some required documents such as immunization records, etc. in the children’s record were missing. LPAs reminded licensee to keep the completed children in care records for review. LPAs also reviewed licensee's file. Licensee's Mandated Reporter certification is current and will expire 10/2023. LPA reminded licensee Mandated Reporter training available www.mandatedreporterca.com must be renewed every 2 years. LPAs reminded licensee all staff whom directly work with children, must complete training.

LPAs observed licensee's and helper’s CPR/First Aid certification were valid. LPAs reminded licensee CPR/First Aid certification must be renewed every two years and must be Emergency Medical Services Authority (EMSA) certified.

LPAs reviewed the records of helper and helper (and the licensee’s mother, she moved in since 9/25/23), there was no immunization record and no valid Mandated Reporter certification were found. As for licensee’s helper/mother, no required documents was found. There was also no fingerprint background check was done. Licensee is reminded to follow up the above said deficiencies. Licensee was cited a Type A citation for their helper/mother without fingerprints background clearance. And Type B citations were issued to the licensee on no fire drill record and the helper did not provide immunization record.

LPAs observed some licensing posters and documents were not properly posted and filed in the home. They were LIC9040 Facility Roster, LIC9148 Earthquake Preparedness and Fire/Earthquake Drill. Licensee was reminded to post and prepare the required documents for review.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
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: LI, YUTING
FACILITY NUMBER: 384004049
VISIT DATE: 09/27/2023
NARRATIVE
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LPAs discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs also informed facility representative 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about ChildCare Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the visit, the licensee, Yuting Li, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPAs discussed with licensee that licensee's mother, who lives in the home, must have fingerprint clearance. Licensee was cited a Type A citation for having an un-fingerprinted adult living in the home. Besides, if the licensee’s mother helping in giving care, she has to get valid trainings of CPR, First Aid and Mandated Reporter Training. Immunization and fingerprint clearance were required.

LPA Tso informed licensee, Yuting Li, that this report dated September 27, 2023 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety or personal rights of children in care.

Also, LPA Tso informed the licensee to provide a copy of this licensing report dated September 27, 2023 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day in the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Yuting Li.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC809 (FAS) - (06/04)
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