<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004726
Report Date: 06/13/2023
Date Signed: 06/13/2023 03:43:34 PM

Document Has Been Signed on 06/13/2023 03:43 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:LIAO, XIU XUEFACILITY NUMBER:
384004726
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
06/13/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Xiu Xue LiaoTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Yee conducted a case management inspection today. The facility requested for an increase in capacity for a large FCCH. Fire clearance was approved on 05/09/2023. LPA and Licensee toured the daycare areas. This is single family home. Present at the facility are licensee, Xiu Xue and 3 daycare children. The facility personnel summary report was reviewed with Xiu Xue and she said it is current. All adults living or working in the home have criminal background check on file. Current residents at the facility are Cecilia, her husband, and their daughters ages 15 year old, 14 year old.

Day Care Areas (lower level): one large room, bathroom, and backyard. The remaining areas are off limit.

Capacity worksheet for large FCCH was explained and provided.

LPA will recommend a large FCCH license effective today, 06-13-2023.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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 1