384004483-9-17-2024-05-CC-JYEE-D97SA6-20240917134149

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004483
Report Date: 09/17/2024
Date Signed: 09/17/2024 01:42:14 PM

Document Has Been Signed on 09/17/2024 01:42 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:	LI, SUSANNA YANNA		FACILITY NUMBER:	384004483
ADMINISTRATOR/ DIRECTOR:	LI, SUSANNA YANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 218-0633
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 8	DATE:	09/17/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Susanna Yanna Li		TIME VISIT/ INSPECTION COMPLETED:	02:00 PM

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Licensing Program Analyst (LPA) Yee conducted an annual inspection visit today. Helper opened the door. The purpose of the visit was explained to the helper. Upon arrival, LPA observed 8 children and two helpers. The licensee, Susanna was not present at the time of the arrival. Helper called Susanna and Susanna arrived at the facility in one hour. The facility personnel summary report was reviewed with Susanna, and she said it's correct. Current residents are Susanna and her boyfriend. All adults living/working at home have fingerprint clearance.

Daycare areas:living room, dining room, bathroom and backyard. The remaining areas of the house are off-limits. The gate leading to upper level is properly barricaded with child safety gates. The licensee, has current CPR, 1ST AID which expires 04/26/2025.

LPA inspected the daycare areas for health and safety hazards. The facility is equipped with a fire extinguisher size 2A10BC. The smoke detector and carbon monoxide are available and working. The home is ventilated properly. The facility does not have bodies of water such as a hot tub in the home. All harmful objects such as chemicals, detergents, cleaning, and medications are made inaccessible to children in care. Electrical outlets have child protective covers in place making them inaccessible to children. All off-limit areas such as bedrooms, kitchen/bathroom cabinets/drawers are made inaccessible to children in care. First aid supplies are available for children. Disciplinary policy was discussed with Licensee today. The home has age-appropriate toys and equipment available for the children in care. The facility provides lunches and snacks. The last fire drill was conducted on 03-20-2024.

LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com. The licensee and helper took general training; both licensee and helper need to take child abuse training. The licensee said she understands. Children files were reviewed. Roster was available and the licensee updated during the inspection.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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: LI, SUSANNA YANNA	FACILITY NUMBER: 384004483
	VISIT DATE: 09/17/2024

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Licensee, Susanna 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.

LPA discussed the safe sleep regulations with the licensee 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 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. Safe Sleep regulations were discussed and provided. Infant activities were discussed. LIC9227 form (infant under 1 year old) was discussed. Sleep log was discussed (infant, newborn to 2 year old must be checked every 15 mins and logged).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at: http://www.ada.gov/childqanda.htm

The licensee, Susanna was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Susanna was confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Capacity worksheet was explained and provided.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted and the report was reviewed with the licensee, Susanna.

The licensee has advised any additional questions to call Office, M-F, 8 am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/17/2024 01:42 PM - It Cannot Be Edited

Created By: Jennifer Yee On 09/17/2024 at 01:30 PM

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: LI, SUSANNA YANNA	FACILITY NUMBER: 384004483
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home 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
1 2 3 4	Based on record review, S1 is missing TB, and MMR. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/01/2024
	Plan of Correction
1 2 3 4	The facility may submit the records via email by due date.

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:

Ali Zebila

LICENSING EVALUATOR NAME:

Jennifer Yee

LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

LIC809 (FAS) - (06/04)

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