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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004546
Report Date: 10/25/2023
Date Signed: 10/25/2023 06:23:57 PM

Document Has Been Signed on 10/25/2023 06:23 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LIU, JINGFACILITY NUMBER:
384004546
ADMINISTRATOR:LIU, JINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 349-1068
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:13 PM
MET WITH:Jing LiuTIME COMPLETED:
06:45 PM
NARRATIVE
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On October 25, 2023, Licensing Program Analysts (LPAs) Tso and Van conducted an unannounced, annual visit to the Family Child Care Home listed above. The LPAs were granted entry by the Licensee, Jing Liu. LPA Tso is a bilingual Chinese and performing Mandarin interpretation. The visit was conducted in Mandarin. LPAs explained the purpose of the visit. LPA observed that there are 4 infants and 1 preschool aged child in care, while the helper is on leave today. Licensee is not operating within capacity limits and ratio during LPA's visit. (Type A deficiency issued, please refer to LIC809D). The hours of operation are Monday through Friday, 8:30 am – 5:30 pm.

Licensee lives in the multi-level home with their spouse and 2 minor children. All adults living in the home have fingerprint clearance on file. The Daycare Areas are on the first floor, consisting of a reception room, a living room, bathroom, and front yard. During the inspection, the licensee clarifies that the reception room is part of the day care area. The off-limit areas are the kitchen, storage room, bedroom, study room/reception room, and garage on the first floor and the entire upper level. All off-limit areas are appropriately barricaded.

The LPAs and the licensee both performed careful inspections of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPA did not find any walkers, bouncers, or other comparable objects during today’s inspection. According to the licensee, there are reportedly no firearms or other weapons on the premises. The LPA found that the facility did not have any bodies of water.

The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The Licensee is aware that smoking is not permitted in a family childcare facility.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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 5
Document Has Been Signed on 10/25/2023 06:23 PM - It Cannot Be Edited


Created By: Man Tso On 10/25/2023 at 04:34 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: LIU, JING
FACILITY NUMBER: 384004546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the Licensee did not comply with the section cited above. Upon entering the home, LPAs observed the licensee was supervising 5. Among the five children, 4 were infant age, and 1 was preschooler. The Licensee did not follow her license limitations, which pose an immediate health, safety, or personal rights risk to persons in care
POC Due Date: 10/26/2023
Plan of Correction
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The Licensee must adhere to her License's limitations and requirements. When the Licensee is alone without an assistant, the Licensee shall comply with the capacity requirements for a Small Family Child Care Home. A written plan will be created by the licensee and submitted to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Man Tso
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/25/2023 06:23 PM - It Cannot Be Edited


Created By: Man Tso On 10/25/2023 at 04:34 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: LIU, JING
FACILITY NUMBER: 384004546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review, the licensee's CPR/ First Aid certificate expired in 9/23. It did not comply with the abovementioned section, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 11/17/2023
Plan of Correction
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Per the licensee, they make the appointment for CPR/First Aid training on 11/11/23. LPA reminded the licensee must ensure to complete the CPR/First Aid Training bi-annually and are available for review during the inspection. The licensee states they will send the ceritificate to LPA by November 17, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Man Tso
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023


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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LIU, JING
FACILITY NUMBER: 384004546
VISIT DATE: 10/25/2023
NARRATIVE
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Bathroom for children's use was observed to be in proper working condition. LPAs did not observe any hazardous materials to be accessible to children. Entire frontyard is fully enclosed and fenced. Outdoor area is equipped with a variety of toys and materials. There is a play structure in the frontyard that was observed to be in good condition. Flooring in backyard includes artificial grass that was observed to be clean. During the inspection, LPAs observed that the licensee cannot hear the doorbell ringing when giving care to the children at the living room. LPAs reminded the licensee be aware of the outside situation to prevent potential hazardous to children in care.

LPAs reviewed five children’s records. Children’s files have a record of emergency identification information on file. Licensee's Pediatric First Aid/CPR is expire 09/2023. Per licensee, an appointment of the training is on 11/11/23. (Type B deficiency issued, please refer to LIC809D). LPAs observed that there is no immunization record on the file. Per licensee, they would send LPA by email by 11/9/23 as need to take care of child at the moment, so that they cannot go upstairs to search. Fire drills are properly logged and maintained. Last fire drill was conducted 06/15/2023.
Per licensee, they construe needless to do the 15-minute check and records for the infants between 12 months and under 24 months. LPA clarified and reminded licensee the safe sleep requirements (Technical Violations issued).
Licensee has licensing documentation properly posted and available for review. Per licensee, there are no weapons or firearms in the home.

LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training.

Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LIU, JING
FACILITY NUMBER: 384004546
VISIT DATE: 10/25/2023
NARRATIVE
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Licensee 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 licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the licensee, Jing Liu, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See 809D for Type "A" and “B” deficiencies issued today. The Facility is advised to provide a copy of the Evaluation Report and the Type "A" Deficiency cited to the parents and guardians of children currently enrolled in care and parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report will be maintained in the facility file and made available for public review three years after the thirty-day posting requirement has been met.

A notice of site visit was given to the licensee and must remain posted for 30 days

Exit interview conducted and report was reviewed with the licensee, Jing Liu.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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