384004749-5-29-2024-05-CC-BVAN-D5R493-20240529185340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004749
Report Date: 05/29/2024
Date Signed: 05/29/2024 06:54:03 PM

Document Has Been Signed on 05/29/2024 06:54 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/ DIRECTOR:	WU, XIULING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 324-9002
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 11	DATE:	05/29/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:15 PM
MET WITH:	Wu, XiuLing		TIME VISIT/ INSPECTION COMPLETED:	07:00 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 May 29, 2024, Licensing Program Analyst (LPA) Van conducted a random annual inspection and met the licensee, Xiu Ling Wu. The purpose of the inspection was explained to the Licensee, who granted LPA entry into the home. The licensee and her helper supervised eleven children (3 infants and 8 preschoolers). The licensee complies with the licensing capacity and limits today. During the visit, the licensee's husband, who also works as her helper, returned home. All the children got picked up at 5 pm. All adults working or residing at the home have had criminal clearance verified by the CDSS Guardian System. According to the licensee, the previously approved childcare areas remain the same, with the same off-limits and childcare areas. 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; the lower level, including the garage and the rest of the home. All off-limit areas are made inaccessible to children. The days and hours of operation will be Monday through Sunday, 6:00 a.m. to 10:00 p.m. During the inspection, the LPA thoroughly checked the childcare areas for potential health and safety hazards. It was noted that the childcare areas were clean and well-maintained. Additionally, the fireplace was properly secured with a bookshelf, and all materials and surfaces accessible to children were clean and toxins-free. Age-appropriate toys, including imaginative, creative, and manipulative play items, were present in the childcare areas. Furthermore, the heating, lighting, and ventilation of the childcare areas were deemed appropriate. The home has a fully charged fire extinguisher labeled 2A 10 BC, a carbon monoxide detector, and multiple combinations of carbon monoxide and smoke detectors. In case of emergencies, a functional phone is readily available. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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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Document Has Been Signed on 05/29/2024 06:54 PM - It Cannot Be Edited

Created By: Brendon Van On 05/29/2024 at 06:16 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: WU, XIULING	FACILITY NUMBER: 384004749
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/29/2024

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
1 2 3 4	Based on the record review, the Licensee did not comply with the section cited above. Licensee and her helpers have not completed their Mandated reporter training, which poses/posed a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 06/07/2024
	Plan of Correction
1 2 3 4	The Licensee must ensure that the Mandated Reporter Training is completed every 2 years and available for review during the inspection. The Licensee states she and her helpers will conduct the training on or before June 7, 2024. A return visit is necessary to ensure the deficiency has been corrected.

Type B

Section Cited

CCR

102416.3(a)(6)

Alterations to Existing Building or Grounds

(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee utilized the kitchen without prior approval from the Licensing (off-limit area). This poses a potential health and safety hazard to children in care.
	POC Due Date: 06/07/2024
	Plan of Correction
1 2 3 4	Licensee is required to create a written plan and notify all assistants about areas that are off-limits. Additionally, the licensee must seek permission to include any off-limit areas in her license before using them.

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Brendon Van

LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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: 05/29/2024

NARRATIVE

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LPA observed a disinfectant spray stored in the bathroom, accessible to children. The Licensee immediately removed it and stored it in a high cabinet. LPA reminded the Licensee that all cleaning products must be stored inaccessible to children or in a locked cabinet. A technical violation was issued.

Licensee stated that no firearms or weapons were present on the premises. LPA did not observe baby walkers, bouncers, or similar equipment in the childcare areas, and the licensees were reminded that smoking is prohibited in the family childcare home.

During the inspection, LPA observed two playpens in the nap room. LPA noticed the bedsheet on one of the play yard paddings was loose and reminded the Licensee that all bedsheets must be tightly fitted. The Licensee explained that she planned to remove all sheets from the play yards as she couldn't find any fitted sheets. LPA reminded the Safe Sleep Regulation with the Licensee. LPA emphasized the importance of adhering to the guidelines for cribs and playpens. LPA informed the Licensee that toys, blankets, or pillows should not be placed inside these sleeping areas, and no objects should be hung above them or on the sides. It was also mentioned that the mattresses must be designed specifically for cribs and playpens, and bed sheets must be tightly fitted. LPA also informed the Licensee that monitoring the infant every 15 minutes during naptime is mandatory. These checks must be consistently documented and kept in the infant's file for review by the Department.

The backyard was fenced entirely with age-appropriate playthings and was free from any hazards or debris that could pose a risk to the children in care. LPA reminded the licensee to roll up the water after use to prevent tripping hazards.

All the required posting documentation, such as the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist, have been placed in a prominent area for parents or representatives to review. According to the licensee, regular fire and earthquake drills are conducted monthly, with the most recent drills completed on May 8, 2024.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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: 05/29/2024

NARRATIVE

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The Licensee maintains records for each child, including vaccination records and complete emergency information. These emergency documents contain information such as the child's full name, phone number, and the location of a parent or authorized person who may be contacted in an emergency. The records also contain the name and phone number of the child's doctor and the parent's permission for the licensee to consent to emergency medical care if needed.

The licensee and helpers have valid Pediatric First Aid certifications on file. However, the mandated reporter training for all staff had expired, and the TB clearances for both helpers were not on file or available for review.

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.

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the licensees 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.

Incidental 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: www.ada.gov/childqanda.htm.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: 05/29/2024

NARRATIVE

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Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Licensee 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

During the exit interview, the LICENSEE, XIULING WU, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

See 809D for deficiencies cited today.

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, XiuLing Wu.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC809 (FAS) - (06/04)

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