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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004726
Report Date: 05/05/2023
Date Signed: 05/05/2023 10:02:15 AM

Document Has Been Signed on 05/05/2023 10:02 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:LIAO, XIU XUEFACILITY NUMBER:
384004726
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/05/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Xiu Xue Liao aka CeciliaTIME COMPLETED:
10:30 AM
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Licensing Program Analyst, LPA Yee conducted a pre-licensing inspection today. This is a change of location from Carrizal St (384002678). LPA and Cecilia toured the entire home for health and safety hazards. Current residents are Cecilia, her husband, and their daughters ages 15 yr old, 14 yr old. Days and hours of operation: Monday to Friday between 7:00 AM to 7:00 PM.

Day Care Areas: (lower level): one large room, and bathroom. The backyard is not licensed today, if used, it needs to be inspected by licensing department. Off-limit areas: The entire upper level and one bedroom are located on the ground floor. The licensee owns the home. The control of the property documentation is on file. The home is equipped with a carbon monoxide detector, a smoke detector, and a fire extinguisher size 2A10B. LPA advised them to conduct emergency drills once every six months and keep a log sheet.
CPR and 1st aid are current until 04-23-2025. The facility does not have a body of water such as a swimming pool, or hot tub. Discipline policy was discussed. The facility will provide morning snacks, afternoon snacks, and lunches.

LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff members are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. The licensee completed the training on 6/29/2022.

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 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: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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: LIAO, XIU XUE
FACILITY NUMBER: 384004726
VISIT DATE: 05/05/2023
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The licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the applicant 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 the applicant 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.

Individual Infant Sleeping Plan (LIC9227) form was discussed and provided. When the infant is napping, it needs to be checked every 15 mins and documented on a log sheet. A sample log sheet was explained and provided. Technical support for COVID was discussed. Website for forms and regulations: www.ccld.ca.gov.

A capacity worksheet was explained and provided.

Prior to licensure:
The applicant needs to change her address to reflect this current address.


Office: 650-266-8800, Monday-Friday
cclsanbrunocc@dss.ca.gov
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
LIC809 (FAS) - (06/04)
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