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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004189
Report Date: 02/01/2024
Date Signed: 02/01/2024 05:08:07 PM

Document Has Been Signed on 02/01/2024 05:08 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:APPLE TREE CHILDREN CENTER-INFANTFACILITY NUMBER:
384004189
ADMINISTRATOR:LIN, SHUYINGFACILITY TYPE:
830
ADDRESS:1331 HARRISON STREETTELEPHONE:
(415) 695-4726
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY: 16TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/01/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:ShuYing linTIME COMPLETED:
05:30 PM
NARRATIVE
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On February 1, 2024., Licensing Program Analysts (LPAs) Van and Tso conducted an unannounced complaint investigation and met the Owner/Director, ShuYing Lin. During the visit, this case Management report was created to address deficiency that was observed unrelated to the complaint investigation.

During the inspection, LPAs reviewed personnel, signed in and out records of children, and all relevant documents provided by the Director. Based on the records review, two staff members have not had criminal records clearance associated with the facility since they started working at the Center. As a result, the deficiency was cited under section 101170(e)(2) of title 22 under Criminal Record Clearance.

An exit interview was conducted with the owner/director, and a plan of correction was discussed. A copy of this report with the appeal rights was provided, and the signature of this form acknowledges the receipt of these documents. Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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Document Has Been Signed on 02/01/2024 05:08 PM - It Cannot Be Edited


Created By: Brendon Van On 02/01/2024 at 04:45 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: APPLE TREE CHILDREN CENTER-INFANT
FACILITY NUMBER: 384004189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
101170(e)(2)

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101170 Criminal Record Clearance (e) 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: (2)Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement is not met, as evidenced by
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The owner/director must ensure that all employees have criminal record clearance or request a transfer of a criminal record clearance prior to their first day at the Center. The owner/Director states she will not have the two teachers present at the Center tomorrow or any day after that until their criminal records are transferred and associated with the Center. The owner/director will submit the two teachers' transfer requests to the Licensing office today before closing.
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Based on records review of the facility personnel report. Two of the staff members did not have criminal record clearance associated with the Center prior to working. This poses a potential health, safety, or personal rights risk to children in care.
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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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024


LIC809 (FAS) - (06/04)
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