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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004607
Report Date: 08/20/2024
Date Signed: 08/20/2024 02:17:27 PM

Document Has Been Signed on 08/20/2024 02:17 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:CHEN, HELEN Y.FACILITY NUMBER:
384004607
ADMINISTRATOR/
DIRECTOR:		CHEN, HELEN Y.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 385-9552
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
08/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Helen Y. ChenTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Yee conducted an annual inspection today. Upon arrival, LPA rang the doorbell. No answer. LPA waited. A phone call was made. Helen answered the phone and said the doorbell was working, and she was running errands; the helper should answer the door. LPA continues to wait, and no one answers the door. LPA made another phone call. Helen arrived at the facility in 20 minutes. The purpose of the visit was explained. When LPA and Helen entered the facility, LPA observed one helper with 11 children. The facility personnel summary report was reviewed with Helen, and she said it was correct. The current residents are the licensee, Helen, and her children ages 11 and 8. All adults living at the facility have fingerprint clearance.

Daycare areas: (upper level): living room, dining room, kitchen, bathroom, family room and backyard..The remaining areas of the house are off limits. The licensee, Helen has current CPR, 1ST AID which expires 04/2025.

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 8/25/2024, earthquake drill was conducted on 7/28/2024.

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, Helen AB1207 certificate has been expired. Children files, staff files, roster were reviewed.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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: CHEN, HELEN Y.
FACILITY NUMBER: 384004607
VISIT DATE: 08/20/2024
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 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, Helen 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, Helen 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, Helen.

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: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 08/20/2024 02:17 PM - It Cannot Be Edited


Created By: Jennifer Yee On 08/20/2024 at 12:52 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: CHEN, HELEN Y.
FACILITY NUMBER: 384004607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

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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LPA and the licensee, Helen entered the facility together and LPA observed one helper supervising 11 children. Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/20/2024
Plan of Correction
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The licensee arrived at the facility and the deficiency cited is corrected.
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:Jennifer Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/20/2024 02:17 PM - It Cannot Be Edited


Created By: Jennifer Yee On 08/20/2024 at 12:52 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: CHEN, HELEN Y.
FACILITY NUMBER: 384004607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, 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: 09/10/2024
Plan of Correction
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The licensee needs to renew mandated reporter training by due date.
Type B
Section Cited
CCR
102391(b)
Inspection Authority of the Department
(b) The licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations. The Department shall exercise this authority as specified in Health and Safety Code Section 1596.8535(a).

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA waited outside for 20 mins, helper did not answer the door. Because this is the same citation cited within one year, 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. A civil penalty of $250 was issued today.
POC Due Date: 08/20/2024
Plan of Correction
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The licensee, Helen arrived at the facility and let LPA inpsect the facility.
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: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/20/2024 02:17 PM - It Cannot Be Edited


Created By: Jennifer Yee On 08/20/2024 at 12:52 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: CHEN, HELEN Y.
FACILITY NUMBER: 384004607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, C1,C4,C5,C6 missing records, C7,C8,C9.C10.C11 missing files. 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: 10/08/2024
Plan of Correction
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The facility needs to submit missing documents by due date.
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:Jennifer Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
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