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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004213
Report Date: 04/28/2023
Date Signed: 04/28/2023 04:06:02 PM

Document Has Been Signed on 04/28/2023 04:06 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:ZHANG, XIUZHENFACILITY NUMBER:
384004213
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
04/28/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:XiuZhen ZhangTIME COMPLETED:
04:30 PM
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Licensing Program Analyst, LPA Yee conducted a case management inspection today. The licensee requested for increase in capacity. LPA met with the licensee, XiuZhen Zhang, her daughter, and 5 daycare children. LPA and XiuZhen inspected the daycare areas. Current residents are XiuZhen, her husband, their daughter, and son. Days and hours of operation: Monday to Friday between 7:30 AM to 6:00 PM.

Day Care Areas (upper level): living room, dining room, bedroom #1 for napping, bathroom, and outdoor yard. The remaining areas are off-limit. The home is equipped with a smoke detector, carbon monoxide, and a fire extinguisher size 2A10BC. LPA advised the applicant to conduct emergency drills once every six months and keep a log sheet. The facility will provide morning snacks, lunches, and afternoon snacks.

CPR and 1st aid are current until 11/06/2023.

LPA discussed the safe sleep regulations with the applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the applicant 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. LIC9227 was provided. An infant sleep log was provided.

Fire clearance approval is on file.

LPA will recommend a large license effective today, 04/28/23.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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