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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004467
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:37:51 AM

Document Has Been Signed on 05/30/2023 11:37 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:NAMBA, MIHOFACILITY NUMBER:
384004467
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
05/30/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Miho NambaTIME COMPLETED:
11:40 AM
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*** The report was completed off-site due to the children having a scheduled outdoor activity during the visit. Today's report and site visit notice was sent to the Licensee's email. The Licensee's physical signature will be signed on the report and sent to LPA.***

On May 30, 2023., Licensing Program Analyst (LPA) Van met with Licensee Miho Namba for an announced case management inspection. The inspection purpose was to process a capacity increase requested by the Licensee. The Licensee and her husband supervised six preschool-age children today. All adults living and working at the home have fingerprint clearance on file. Per Licensee, there were no changes in the physical plant. All childcare and off-limit areas are the same. The hours of operation will be Monday through Friday, 8:30 am - 4:30 pm. This facility has applied for a capacity increase from 8 to 12 children.

The home is clean and orderly and has sufficient lighting and ventilation. The fire extinguisher is fully charged and meets the requirement. The facility has a smoke detector, carbon monoxide detector, fully charged fire extinguishers, and a working telephone. All harmful objects, sharp objects, and toxins are stored out of the reach of children and made inaccessible to children. There is a full supply of First Aid kits available for the children. The cabinet where the Licensee kept cleaning products/disinfectants was blocked off with a stepping stool to prevent children from accessing it. Per Licensee, there are no guns or weapons in the home. LPA observed that the home has age-appropriate toys and equipment available for the children.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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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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: NAMBA, MIHO
FACILITY NUMBER: 384004467
VISIT DATE: 05/30/2023
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The department received an approved fire clearance from the San Francisco Fire Department on May 15, 2023. All required forms have been submitted to the department.

During the inspection, LPA informed/discussed with the Licensee the following:

· All 18 yrs and older adults living in the home or working at the house must have fingerprint clearance before contacting the children
· LPA reviewed capacity requirements with the Licensee.
· Licensee was informed that Licensee and all helpers must have valid Pediatric FirstAid CPR.
· Mandated Reporter Training. Training must be completed every two years, and training can be taken online at www.mandatedreporterca.com
· Safe-Sleep, Individual Infant Sleeping Plan, and provided Safe Sleep PIN.
· Infant walkers, exersaucers, jumpers, baby bouncers, and similar items are prohibited in the daycare.
· Records to be maintained in the facility were explained—mandatory Posting requirements: License, Emergency Disaster Plan, and Notification of Parents' Rights Poster.
· Reporting Requirements.

Capacity increase for large family child care home will be approved upon supervisor reviews.

No deficiencies were discovered during the inspection. LPA informed the Licensee that a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
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