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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004154
Report Date: 09/02/2025
Date Signed: 09/02/2025 04:07:31 PM

Document Has Been Signed on 09/02/2025 04:07 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: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: 14CENSUS: 0DATE:
09/02/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Peifen (Cynthia) Wang and Jerry ChouTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
NARRATIVE
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On September 2, 2025 at 3:10pm, Licensing Program Manager (LPM), Daniel Oquendo, and Licensing Program Analyst (LPA), Nathan Garcia, met with Licensee, Peifen (Cynthia) Wang and her husband, Jerry Chou for an office meeting.

The purpose of the office meeting was to discuss the citations issued to the Family Child Care Home on July 18, 2025.

Citations discussed during this meeting included:

· Posting Requirements:

-Facility was cited on July 18, 2025, for not having the LIC 9224 signed by the parents of enrolled children.

· Infant Safe Sleep:

-The helper’s infant son was left sleeping alone in the home while the staff and other children are at a public park.

-The same infant child was observed to have a blanket in the crib.

-The facility staff were unable to provide 15-minute sleep logs during the inspection.

· Operation of a Family Child Care Home:

-The facility staff was unable to provide emergency drill logs during the inspection.

-The use of an off-limit area used for day care area.

***continue to page 2***

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2025
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 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: WANG, PEIFEN C.
FACILITY NUMBER: 384004154
VISIT DATE: 09/02/2025
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***Page 2 continued***

Licensee was reminded:

-The licensee must be present in the home for at least 80% of the daily operation hours. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

-Record keeping of children and staff files and to train the staff where to locate the files in an event the licensee is absent.

-Regulations regarding implementing fire drills at least 2 times a year.

-Infant Safe Sleep Regulations.

During the meeting, LPM provided licensee with:

· Licensing regulations.

LPA also cleared the deficiency from July 18, 2025 regarding the LIC 9224 that needed to be signed. Clearance letter provided to Licensee.

Exit interview conducted and report was reviewed with Licensee, Peifen (Cynthia) Wang and her husband, Jerry Chou.

Per licensee, they appreciate the meeting and reiterating the information that was given at the meeting. Licensee states, they spoke with the helper who advised that she had made a unilateral decision to leave the child because he was sleeping with a blanket and not take him to the playground. Licensee states, that proper corrective and further enhanced training was provided to all staff to ensure proper safety protocols are adhered.

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Nathan Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
LIC809 (FAS) - (06/04)
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