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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004341
Report Date: 03/16/2023
Date Signed: 03/16/2023 05:25:02 PM


Document Has Been Signed on 03/16/2023 05:25 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:TEL HI MISSION BAY CHILD CAREFACILITY NUMBER:
384004341
ADMINISTRATOR:MIMI TOMFACILITY TYPE:
830
ADDRESS:188 PIERPOINT LANETELEPHONE:
(415) 580-7223
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY:9CENSUS: 6DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Yayao Yee, Martha Abdelsayed, and Connie LuuTIME COMPLETED:
04:25 PM
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On March 16, 2023 at 9:15 AM, Licensing Program Analyst (LPA) Cowan met with Lead Teacher, Yayao Ye, for an unannounced annual random inspection. The purpose of the inspection was explained, and LPA was granted access to facility. Present today is Lead Teacher, 3 staff, and 6 infants in care. 9:50 AM, Stie Director arrived to continue the inspection with LPA. At 10:15 AM, Program Director, Connie Luu, joined the inspection process. Facility is operating within its capacity, and facility is in compliance with staff / child ratio on this day. The center operates Monday - Friday 7:30 AM to 6:00 PM. The center has two classrooms: Seal Pups (infants) and Piper Peeps (Toddlers). When LPA arrived, children were participating in free play.

LPA inspected the infant day care area for health and safety hazards today. LPA observed facility has installed smoke detector, working carbon monoxide detector, fully charged fire extinguisher, and working telephone on site. The center is clean, orderly and in good repair. There are no pools, spas or other similar bodies of water on site. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All furniture and equipment are clean and in good working condition. The center's furniture and equipment are age appropriate. There is a sufficient quantity of cribs, table/chairs and changing tables meet the capacity. Facility provides bedding for cribs. Facility wipes down to disinfect cribs daily and washes bedding daily. Bottles and other items are labeled and stored appropriately. Changing tables are within an arm’s reach of a sink. LPA observed infants were supervised by staff in the classrooms and in the napping area. All solid waste storage containers have secure lids. The outdoor play area designated for the infants and toddlers was clean and in good repair. All toys and equipment are in working condition.

At 11:39 AM, Staff files were reviewed. All staff have criminal record clearances on file. Education units are on file for teaching staff. At least one staff member on site has current CPR/First Aid certification. At 11:50 AM, LPA observed that a staff member did not have Pertussis and FLU vaccine on file. This is a potential risk to children in care. A Type B citation is issued for this deficiency. At 12:23 PM, Children's files we re reviewed. Children's files have all required Licensing documents on file. LPA discussed not using sleep sacs for napping infants in care. Facility files were discussed.


Report Continues .....
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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 4


Document Has Been Signed on 03/16/2023 05:25 PM - It Cannot Be Edited

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: TEL HI MISSION BAY CHILD CARE
FACILITY NUMBER: 384004341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 1 out of 5 staff did not have Pertussis and FLU vaccine on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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Site director agrees to collect immunizations for Lisha Jiang and email to LPA by the above date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: TEL HI MISSION BAY CHILD CARE
FACILITY NUMBER: 384004341
VISIT DATE: 03/16/2023
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, 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 Child Care Center. 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 director 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 licensee [facility representative] 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.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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/inspection-process.

>See next page for deficiencies

An exit interview conducted and report was reviewed with site director.

This report must be available in the facility for public review. Notice of site visit is to be posted for 30 days. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4