<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004278
Report Date: 01/14/2025
Date Signed: 01/14/2025 12:40:27 PM

Document Has Been Signed on 01/14/2025 12:40 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:YONDONRENTSEN, ZAGDSODNOMFACILITY NUMBER:
384004278
ADMINISTRATOR/
DIRECTOR:		YONDONRENTSEN, ZAGDSODNOMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(628) 777-4866
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
01/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:56 AM
MET WITH:Zagdsodnom YondonrentsenTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/14/2025, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit and met with the Licensee, Zagdsodnom Yondonrentsen. LPA explained the purpose of the visit to the licensee.

Four pre-k children and three infants were present during today’s visit. The two adults caring for the children received criminal record clearance from the California Department of Social Services. The licensee holds a large license and is within capacity limits and ratios for today’s visit.

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, and the Earthquake Preparedness Checklist, were displayed and visible to the public.

The most recent emergency disaster drill was conducted on 12/3/2024, and the LPA observed that it was documented.

Daycare Areas: The living room, family room, kitchen, bathroom on the first level (next to the kitchen), and backyard.

Off-limit Areas: The entire second floor, & garage. The licensee understands that off-limits areas may not be used for childcare during business hours.

LPA inspected the indoor and outdoor daycare areas to identify health and safety hazards. The home has a fire extinguisher, a first aid kit, a carbon monoxide detector, and a smoke detector. LPA tested the carbon monoxide and smoke detector and found both functioning. LPA observed that the home's interior was clean and orderly, with proper heating and ventilation. One bottle of laundry detergent, one bottle of cleaning solution, one bottle of bleach, and one bottle of dish detergent items were in the bottom cabinet of the bathroom, and they were not locked, which made them accessible to the children. LPA discovered the items listed above while the children were in the living room. The bathroom was clean, fully operational, and equipped with suitable toileting equipment and sanitation products.

See Page 2

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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 5
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: YONDONRENTSEN, ZAGDSODNOM
FACILITY NUMBER: 384004278
VISIT DATE: 01/14/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***Amended***

Page 2

LPA observed that the daycare areas had age-appropriate toys, furniture, and educational materials. The fireplace was covered with a child’s storage unit. A designated area was provided for permanent or portable storage of the children's clothing and personal belongings. Electrical outlets were fitted with child safety covers to prevent children's access. A child safety gate was observed at the stairs, preventing access to the upper level. According to the licensee, there are no firearms or weapons on the property.

The backyard is surrounded by a fence and features a variety of outdoor play equipment, all of which are in excellent condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with artificial grass. LPA did not observe any pools, spas, or bodies of water on the property.

The licensee currently provides lunch and snacks for the children in their care. According to the licensee, two enrolled children have a documented allergy.

The facility offers different options for children to rest or nap, including cribs and children's sleeping beds. LPA observed that sheets and blankets were available for the children. Infant mattresses are firm and equipped with appropriately sized sheets. All cribs are well-maintained and free of loose items that could pose safety risks.

LPA reviewed the files of six children and verified that their emergency contact and medical information were complete. LPA attempted to review the 15-minute sleep records for children under the age of two. However, the licensee stated that she does not have these records available for review. LPA requested the licensee to see form LIC 282 for each child, but the licensee stated it was not available for review. Form LIC 282 is to notify parents that the family child care home does not have liability insurance. The licensee stated she currently does not have liability insurance for her family child care home.

LPA reviewed the licensee’s file and confirmed that all required forms were present. LPA found that the licensee has a current Pediatric First Aid/CPR certification, which will expire in July 2025.

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.

See Page 3

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: YONDONRENTSEN, ZAGDSODNOM
FACILITY NUMBER: 384004278
VISIT DATE: 01/14/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 3
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/.

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.

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, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

Please see LIC 809D for today’s citations.

Appeal rights were given to the licensee.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Zagdsodnom Yondonrentsen.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/14/2025 12:40 PM - It Cannot Be Edited


Created By: Hanson Leong On 01/14/2025 at 11:38 AM
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: YONDONRENTSEN, ZAGDSODNOM
FACILITY NUMBER: 384004278

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 01/16/2025
Plan of Correction
1
2
3
4
LPA observed that one bottle of laundry detergent, one bottle of cleaning solution, one bottle of bleach, and one bottle of dish detergent were relocated to the top of an upper cabinet, making them inaccessible to the children.
Deficiency will be cleared during today's visit.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 02/03/2025
Plan of Correction
1
2
3
4
The licensee must submit form LIC 282 for all enrolled children to the department by the deadline mentioned above.
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:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/14/2025 12:40 PM - It Cannot Be Edited


Created By: Hanson Leong On 01/14/2025 at 11:38 AM
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: YONDONRENTSEN, ZAGDSODNOM
FACILITY NUMBER: 384004278

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 02/03/2025
Plan of Correction
1
2
3
4
The licensee must submit infant sleeping logs of all enrolled children to the department by the deadline mentioned above, indicating that children under two are checked every 15 minutes while sleeping.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2025


LIC809 (FAS) - (06/04)
Page: 5 of 5