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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004193
Report Date: 01/03/2024
Date Signed: 01/03/2024 11:38:50 AM

Document Has Been Signed on 01/03/2024 11:38 AM - 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:LI, XIAO JUANFACILITY NUMBER:
384004193
ADMINISTRATOR:LI, XIAO JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 517-2821
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
01/03/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Xiao Juan LiTIME COMPLETED:
11:45 PM
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On January 3, 2024., Licensing Program Analyst (LPA) Van conducted a required inspection and met the Licensee, Xiao Juan Li. LPA explained the purpose of the inspection to the Licensee and was given access to the property. The licensee and her helper supervised 9 children today, six preschool ages and 3 infants. The Licensee complies with the licensing capacity and limits today. All adults who live or work in the house have a criminal background check. There are no changes to the childcare areas previously approved, with the same off-limits and childcare areas. Day Care Area is provided on the first level only. The daycare areas consist of a playroom, bathroom, and backyard. Off-limit areas are a sunroom, the garage on the first floor, and the entire second floor. The days and hours of operation are Monday – Friday from 7:30 am – 6:00 am. The Licensee has valid childcare liability insurance on file.

LPA and the Licensee inspected the childcare areas for any potential dangers to health and safety hazards. LPA observed the childcare areas were in good condition and clean. The activities provided were age-appropriate and included imaginative, creative, and manipulative play. Moreover, the heating, lighting, and ventilation were sufficient, and there were no potential hazards that could endanger children in care. The Licensee had a fully charged fire extinguisher that met the minimum standards of 2A 10 BC, along with a combination of carbon monoxide and smoke detector. A functional phone was also available in case of emergencies. Cleaning agents and detergents were safely stored out of children's reach, and the Licensee confirmed that no firearms or weapons were present on the premises. LPA did not observe baby walkers, bouncers, or similar equipment in the childcare areas, and the Licensee was reminded that smoking is prohibited in the family childcare home. The backyard was completely fenced with age-appropriate playthings and was free from any hazards or debris that could potentially pose a risk to the children in care. A soft cushion is underneath the play structure to prevent accidental falls.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LI, XIAO JUAN
FACILITY NUMBER: 384004193
VISIT DATE: 01/03/2024
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During the inspection, LPA reviewed and discussed the Safe Sleep Regulation with the Licensee. LPA emphasized the importance of adhering to the guidelines for cribs and playpens. Licensee was reminded that toys, blankets, or pillows should not be placed inside these sleeping areas, and no objects should be hung above them or on the sides. It was also mentioned that the mattresses used must be designed specifically for cribs and playpens, and bed sheets must be tightly fitted. LPA also informed the Licensee that monitoring the infant every 15 minutes during naptime is mandatory. These checks must be documented and kept in the infant's file for review by the Department.

The licensee and helper have maintained complete records and have met all the necessary licensing requirements, including completing required immunizations, mandated reporter training, and maintaining a valid Pediatric CPR/First Aid certification. All the required posting documentation, such as the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist, have been placed in a prominent area for parents or representatives to review. According to the licensee, regular fire and earthquake drills are conducted at least once every six months. The latest drills were completed on 12/15/2023

Random children's records were reviewed. The licensee maintains accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. These emergency documents contain information such as the child's full name, phone number, and the location of a parent or authorized person who may be contacted in an emergency. The records also contain the name and phone number of the child's doctor and the parent's permission for the licensee to consent to emergency medical care if needed.

During the inspection, LPA reviewed Forms/Records to Keep in Your Family Child Care Homes, children's forms/records, and personnel forms/documents with the Licensee. In addition, license capacity and limitations were also reviewed with the licensee.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LI, XIAO JUAN
FACILITY NUMBER: 384004193
VISIT DATE: 01/03/2024
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LI, XIAO JUAN
FACILITY NUMBER: 384004193
VISIT DATE: 01/03/2024
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LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

During the exit interview, the LICENSEE, XIAO JUAN LI, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

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

An exit interview was conducted, and the report was reviewed with the licensee, Xiao Juan Li.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
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