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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004483
Report Date: 11/03/2023
Date Signed: 11/03/2023 02:09:58 PM

Document Has Been Signed on 11/03/2023 02:09 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 YANNAFACILITY NUMBER:
384004483
ADMINISTRATOR:LI, SUSANNA YANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 218-0633
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
11/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Yuling Wei, Guifang LaoTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst, LPA Yee conducted a case management visit today. Present at the facility are two helpers and 8 children. The licensee, Susanna is not present during the inspection. LPA and helper, Guifang toured the home. LPA observed the following deficiencies and issued citations

1) A four-month-old infant napping inside the play yard with a blanket on top. This is a repeated violation, a civil penalty of $250 was issued today.

2) A 16-month-old infant is napping on the child's sofa bed with Boppy pillow underneath.

3) The licensee does not live in the home

4) The licensee is not at the facility 80% of the time.

The office meeting is scheduled for November 13, 2023. An informal office letter invitation was hand-delivered during today's visit.

See next page for Type A and B citations.

The facility was advised to post and provide copies of this report to parents and guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents shall sign the LIC 9224 as proof of receipt. Appeal Rights was provided.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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 3
Document Has Been Signed on 11/03/2023 02:09 PM - It Cannot Be Edited


Created By: Jennifer Yee On 11/03/2023 at 01:20 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: 11/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2023
Section Cited
CCR
102425(b)

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102425(b) Infant Safe Sleep:
Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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A blanket was removed after LPA mentioned it to the helper.
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LPA observed a blanket on top of the 4 month old infant and a 16 month old infant with boppy pillow. Based on observation, the licensee did not comply with the section cited above which poses an immediate safety risk to children in care.

This is a repeated violation. A civil penalty of $250 was issued.
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Type A
11/03/2023
Section Cited
CCR102425(a)(1)

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102425(a)(1) Infant Safe Sleep:
There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

(1) All cribs or play yards shall meet the United States Consumer Product Safety Commission safety standards.
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The staff said she will clean one of the play yard and will place the 16 months old inside the play yard.
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This requirement is not met as evidenced by:

LPA observed a 16 months old infant napping on a child sofa bed with blanket and boppy pillow underneath. Based on observation, the licensee did not comply with the section cited above which poses an immediate safety risk to children in care.
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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:Ali Zebila
LICENSING EVALUATOR NAME:Jennifer Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/03/2023 02:09 PM - It Cannot Be Edited


Created By: Jennifer Yee On 11/03/2023 at 01:35 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: 11/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2023
Section Cited
CCR
102352(h)(1)(b)

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102352(h)(1)(b):
Home" means the licensee's residence as defined by Government Code Section 244.

In determining the place of residence the following rules shall be observed:

(a) It is the place where one remains when not called elsewhere for labor or other special or temporary purpose, and to which he or she returns in seasons of repose.
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The licensee needs to surrender the license or this location must be her primary home. Follow up visit and/or office meeting will be scheduled.
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This requirement is not met as evidenced by

Based on today's inspection and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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Type B
11/13/2023
Section Cited
CCR102417(a)

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102417(a) Operation of a Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
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The licensee needs to be present at the facility to ensure the children are supervised at all times. Failure to correct will result civil penalty. Follow up visit and/or office meeting will be scheduled.
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This requirement is not met as evidenced by
Based on today's inspection and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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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:Ali Zebila
LICENSING EVALUATOR NAME:Jennifer Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2023


LIC809 (FAS) - (06/04)
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