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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004154
Report Date: 07/22/2024
Date Signed: 07/22/2024 05:31:30 PM

Document Has Been Signed on 07/22/2024 05:31 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:WANG, PEIFEN C.FACILITY NUMBER:
384004154
ADMINISTRATOR/
DIRECTOR:		WANG,PEIFEN C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 966-8109
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
07/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Licensee, Peifen C. WangTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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On 7/22/2024, at approximately 3:05PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Peifen C. Wang, and explained the purpose of the visit. Present during the visit was Licensee, a helper, six 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.

Daycare Areas: Daycare Room 1, Daycare Room 2, Bathroom, and Backyard.
Off-limits Areas: Laundry Room, Office, Garage, and entire Upper Level.

LPA inspected the facility for any health or safety hazards. There is a fully charged 2A10BC fire extinguisher present. LPA observed the carbon monoxide detector to be operational. Stairs are barricaded and inaccessible to children in care. Off-limits areas are kept inaccessible with childproof locks or barricades. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. LPA advised that all childproof latches and locks should be checked frequently to ensure that they are still functional.

LPA observed age-appropriate toys and learning materials to be present in Daycare Room 1. Furniture was observed to be age-appropriate and free of rough or sharp edges. The facility provides cots for preschool age children to nap on. There are cribs available for infants. Blankets are brought from home and taken back once a week for washing. Per Licensee, the facility provides breakfast, lunch, and afternoon snack for children in care.




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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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: WANG, PEIFEN C.
FACILITY NUMBER: 384004154
VISIT DATE: 07/22/2024
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LPA observed the Backyard to be free of debris and other loose articles. There are age-appropriate toys and equipment. The Backyard is enclosed by a fence that is at least four feet high. Per Licensee, children are taken on walks to nearby parks for play. There are no pools or other similar bodies of water present in the facility. Per Licensee, there are no weapons or firearms stored in the facility.

LPA reviewed three staff files, five children’s files, and facility records. Licensee’s First Aid/CPR expires 12/2025. Licensee’s Mandated Reporter Training expires 9/2025. Staff immunizations are available for review. LPA observed all children’s files to be complete. All required postings were observed to be accessible for review immediately upon entry to the facility. LPA advised that emergency drills must be logged. LPA discussed infant sleeping logs with Licensee. LPA advised that logs are required to be done every 15 minutes.

LPA observed that the Office in the lower level of the home was used as a napping area. The Department has not received notice of the addition to the daycare areas. LPA advised that the Office shall not be used until fire clearance is acquired and a follow-up inspection is conducted. Licensee stated that they would not be adding the Office as a daycare area.

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: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
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: WANG, PEIFEN C.
FACILITY NUMBER: 384004154
VISIT DATE: 07/22/2024
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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 7/22/2024. See LIC9120-TV for technical violations issued today regarding reporting requirements, emergency drills, and safe sleep. See LIC9102-TA for technical assistance provided today regarding childproof latches and locks.
A notice of site visit was given and must remain posted for 30 days.

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

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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