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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004378
Report Date: 03/23/2023
Date Signed: 03/23/2023 02:54:16 PM

Document Has Been Signed on 03/23/2023 02:54 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:LU, BAOWENFACILITY NUMBER:
384004378
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Lu, Baowen (Angela)TIME COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, BaoWen Lu (Angela) and licensee's mom who was a daycare helper. LPA explained the purpose of the inspection to her. There were 6 children including 2 infants present with a helper upon LPA's arrival. The licensee owned and lived in the 2 story single family house with her 2 minor children. The facility was called Banana Boat Family Day Care". . The facility's operation hours were Monday to Friday from 8 AM to 5:30 PM. The main entrance of the facility was located next to the garage door. Day care areas were on the ground level including utility room (main play room),a bedroom, & a half bathroom. OFF- Limit areas were the entire upper level, a garage and a backyard. LPA inspected the facility for health and safety hazards. The temperature and lighting were adequate. The licensee made the toxins and harmful objects inaccessible to the daycare children. Gates were installed at the entrance to the main play area, entrance to upper level, and bedroom's entrance. The licensee installed the soft cushioning to entire daycare floor to prevent injury except kitchen area. There were plenty of age-appropriate toys, slide structure, ride-on toys, books, learning materials, and children furniture that was in good condition and repaired. There were a fully charged 2A10BC fire extinguisher, a working cellular phone, and first aid supplies available in the facility. LPA did not test the smoke and carbon monoxide detectors due to napping during the inspection. The licensee latched the lower sink cabinets. The children's bathroom was clean. The licensee made the toxins and harmful objects inaccessible to the children there. All electrical outlets were covered. Cribs and mats were used for napping. Boosters were used for feeding only; the children need to be removed from it after they finish the meals. The licensee has provided breakfast, AM/PM snacks, lunch, and dinner to the children. The fire drill has been conducted with the children as least 2 times a year. Per licensee there was a child on special medication. Per licensee, there was no guns, weapons or pets in the house. The licensee had current CPR/First Aid training which will expire in 6/2024 and Child Abuse Mandated Reporter Training which will expire in 2/2025. LPA reviewed the children's file, 15 minutes nap check log, and obtained a copy of the current children's roster during the inspection. The licensee posted all the required postings in the daycare areas.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
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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