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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004486
Report Date: 09/06/2024
Date Signed: 09/06/2024 10:42:15 AM

Document Has Been Signed on 09/06/2024 10:42 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:LITTLE ANGELS JAPANESE PRESCHOOLFACILITY NUMBER:
384004486
ADMINISTRATOR/
DIRECTOR:
HIRAI, HISAMIFACILITY TYPE:
850
ADDRESS:2545 JUDAH STREETTELEPHONE:
(415) 564-6123
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 2DATE:
09/06/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Hisami HiraiTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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On September 06, 2024 at approximately 8:30am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Plan of Correction (POC) Visit and met with Site Director, Hisami Hirai during the visit. Purpose of the inspection was explained. There was no children in care when upon LPA arrival. At approximately 9:00am, 2 children arrived at the facility. LPA observed parents signed their children in by the entrance with the clipboard. Per Director, she currently has only 2 children enrolled.

The POC visit is regarding Type B deficiencies cited on 07/29/2024:
1. At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. Director or Staff did not have proof of completed Pediatric CPR/First Aid.
2. A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. Program enrolled 2 school age children.
3. Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. Children in care did not have medical assessments on file.
4. The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center. Children's files were not complete. All children files did not have required licensing forms.

During today's visit, LPA cleared the following deficiencies by visit and issued a letter of clearance to facility Director.
1. LPA reviewed Director proof of pediatric cardiopulmonary resuscitation and pediatric first aid certificate valid until 01/2026.
2. Director confirmed school age children are no longer enrolled.

During today's visit, LPA is unable to clear deficiencies regarding children's record as records are still not available for review. Director has been advised to email children's completed required licensing forms, immunization record to LPA by 09/20/2024.

A copy of this report and appeal rights were discussed and will be emailed to Director whose signature on this form confirm have read the reports. Notice of Site Visit will also be emailed. Notice to remain posted for 30 days. For updates 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: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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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