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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004099
Report Date: 11/13/2024
Date Signed: 11/13/2024 01:25:01 PM

Document Has Been Signed on 11/13/2024 01:25 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:CHEN, AMY MAFACILITY NUMBER:
384004099
ADMINISTRATOR/
DIRECTOR:		CHEN, AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 806-8633
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
11/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Licensee, Amy ChenTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 11/13/2024, at approximately 11:40AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Amy Chen, and explained the purpose of the visit. Present during the visit was Licensee, a helper, seven preschool age children, and one infant. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:00AM to 5:30PM, Monday to Friday.

Daycare Areas: Living Room, Dining Room, Bedroom #1, Bathroom, and Backyard.
Off-limits Areas: Bedroom #2, Kitchen, and the Garage.

LPA and Licensee inspected the home for any health or safety hazards. There is a fully charged fire extinguisher that is at least size 2A10BC. There are operational carbon monoxide and smoke detectors present throughout the home. There is a fireplace in the Living Room that has been covered to be inaccessible. Electrical outlets are childproof and are covered or blocked by furniture when not in use. There are heating and ventilation controls available for the comfort and safety of children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Stairs are kept inaccessible to children with childproof gates.

LPA observed age-appropriate toys and learning materials to be present in the Living Room and the Dining Room. Furniture is age-appropriate and free of rough or sharp edges. Children have access to blocks, manipulatives, and books. LPA observed one crib to be present in Bedroom #1. There was a firm mattress that was equipped with a fitted sheet. Preschool age children nap on mats. The facility provides bedding for children to nap with. Bedding is brought home once a week for cleaning. Licensee stated that the facility provides lunch and AM/PM snacks. Children bring breakfast as needed.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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: CHEN, AMY MA
FACILITY NUMBER: 384004099
VISIT DATE: 11/13/2024
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LPA observed the Backyard to be free of debris and other loose articles. There are age-appropriate toys and equipment available for children. There is resilient padding present. The Backyard is enclosed by a fence that is at least four feet high. The fence was observed to be in good repair. There are no swimming pools or other similar bodies of water present. Licensee stated that there are no firearms or weapon in the home.

LPA reviewed two staff files, eight children’s files, and facility records. Licensee’s Pediatric First Aid/CPR expires 1/2025. Both staff files contained current Mandated Reporter training. All adults present have acquired fingerprint clearance and are associated to the facility. LPA observed all children’s files to be complete. Infant sleeping logs are readily accessible for review. All required postings are posted and accessible for review upon entry to the facility. The facility last conducted an emergency drill on 9/30/2024. Emergency drills are properly logged and documented. Drills are posted and available for review in the Kitchen.

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: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CHEN, AMY MA
FACILITY NUMBER: 384004099
VISIT DATE: 11/13/2024
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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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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

No deficiencies were cited during today’s visit on 11/13/2024. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Amy Chen.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC809 (FAS) - (06/04)
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