384004749-6-28-2023-05-CC-BVAN-CT93EU-20230628181144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004749
Report Date: 06/28/2023
Date Signed: 06/28/2023 06:11:50 PM

Document Has Been Signed on 06/28/2023 06:11 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:	WU, XIULING		FACILITY NUMBER:	384004749
ADMINISTRATOR:	WU, XIULING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 324-9002
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	06/28/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	XiuLing Wu		TIME COMPLETED:	06:15 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	On June 28, 2023, Licensing Program Analyst (LPA) Van met with the Licensee, Wu Xiu Ling, for a Pre-Licensing relocation inspection. The Licensee has relocated from Facility #384004610 to this location. The purpose of the inspection was explained, and LPA granted entry to the home by the Licensee. The Licensee currently has a large license. There were no children present during the inspection. Operation hours are Monday – Sunday from 7:00 am – 10:00 pm. All staff and adult residents have fingerprint clearance on file. Control of Property was on file. San Francisco Fire Department signed off the fire clearance on June 12, 2023. Licensee and LPA inspected the inside and outside of the home for health and safety Hazards. The Licensee owns this single-family home, consisting of two levels with three bedrooms and one bath. The home's residents are Licensee, her mom, and a minor daughter. Childcare areas are the second level's living room, dining room, primary bedroom/nap room, bathroom on the second floor, sunroom on the ground floor, and back yard. Off-limit areas are two bedrooms on the second level and the lower level, including the garage and the rest of the home. The home has age-appropriate toys and equipment available for children in care. The house has multiple combinations of working smoke and carbon monoxide detectors, a working telephone, and a fully charged 3A 40 BC fire extinguisher. First Aid Kit is fully stocked and accessible. There are no pools, spas, or bodies of water on the property. All cleaning supplies, poisons, and other chemicals are inaccessible to children. All harmful and sharp objects are made inaccessible to children in care. The Licensee stated there are no guns, weapons, or pets in the home. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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: WU, XIULING	FACILITY NUMBER: 384004749
	VISIT DATE: 06/28/2023

NARRATIVE

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LPA reminded the Licensee to conduct an emergency drill once every six months, and log drills are required. The licensee’s First Aid/CPR certificate expires on 5/12/2025. The right side of the living room wall will be the posting area. The Licensee is reminded of NO walkers, jumpers, bouncers, or any similar items to be used for children in care and shall be made inaccessible. In addition, smoking is prohibited at the daycare.

During the inspection, the following was discussed and reviewed with the Licensee:
· Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
· Incidentals Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
· The Licensee was reminded of the Department Inspection Authority. An employee or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice,
· The Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation, and PIN 20-01-CCP Required Lead Testing for Drinking Water
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, XIULING	FACILITY NUMBER: 384004749
	VISIT DATE: 06/28/2023

NARRATIVE

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·The Licensee was reminded that 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.
· The Licensee was reminded about Mandated Reporter training available on the CCLD website. Training must be completed every two years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is unavailable in the native language, a statement can be written stating exemption until the translation is available.
· The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website.
· The Licensee was reminded for any additional questions to contact the CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.
· Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents’ Rights Poster.
· Capacity limits of a Large License were discussed with Licensee. The Licensee was reminded that a Helper must be present when operating at a large capacity, and all helpers require Pediatric First Aid CPR.

Prior to licensure, the following issues need to address.
- Licensee must install child-proof gates to three entrances/exits in the kitchen.
- Install a bell or chime for the side gate in the backyard.

The report was reviewed and signed by the Licensee, Wu Xiu Ling. A copy of today's report was provided to the Licensee. No deficiencies are cited today under the California Code of Regulations, Title 22, Division 12.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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