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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004755
Report Date: 08/18/2023
Date Signed: 08/18/2023 01:12:19 PM

Document Has Been Signed on 08/18/2023 01:12 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:SHU, CHUNHUAFACILITY NUMBER:
384004755
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/18/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Chunhua ShuTIME COMPLETED:
01:26 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 August 18, 2023 at 11:20 AM, Licensing Program Analyst (LPA) Cowan conducted a pre-licensing inspection this day. The applicant is applying for a small family childcare license. Applicant lives in a 2 bedroom and 3 bathroom apartment with adult child. They are both present this day. he applicant states that this is their primary residence where they live full time. The day-care operates 7:30 AM to 6:00 PM, Monday through Sunday.

Applicant states that they understand that they are the primary person responsible for operating and providing care and supervision to the children, regardless if the applicant hires helpers or assistants to work with them. Applicant understands that they may only be absent from the home no more than twenty percent of the operating hours. During the twenty percent absence applicant understands that they may designate another person to provide care and supervision to the children who is qualified with Mandated Reporter Training, Pediatric CPR and First Aid Training, has obtained criminal record clearances, child abuse index checks, a TB test with results, immunizations as required by law, and has a signed Criminal Record Statement and Acknowledgement to Report Suspected Child Abuse forms.

Capacity and ratio options were reviewed with the applicant today. Applicant understands that care cannot be provided for more than the capacity as stated on the license. Applicant will require parent’s sign the affidavit for liability insurance or obtain adequate liability insurance.

During today’s inspection, LPA toured the home and yard. LPA observed the following today:
Childcare areas are located on the lower level of the home. Living Room, Dining Area, and lower level bathroom.
The entire upper level of the home is off-limits: Kitchen, bedrooms 1 and 2, and bathrooms 2 and 3.

Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. There are no bodies of water on the property. There is no fireplace in the home. There are no detergents, or cleaning products accessible to day-care children. Applicant states there are no guns or weapons of any kind in the home. There are no pets in the home.
Report Continues......
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2023
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 3
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: SHU, CHUNHUA
FACILITY NUMBER: 384004755
VISIT DATE: 08/18/2023
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
26
27
28
29
30
31
32
Page 2
Care and Supervision and transportation of children was discussed. Visitors to the home was discussed. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. Isolation of sick children reviewed/discussed. Discipline used will be redirection and.

LPA reviewed the required day-care forms with the applicant. Records for Children and staff/helper files were reviewed. Required Postings were discussed. All required postings are properly posted (Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist). Applicant understands emergency drills must be conducted at least once every six months and be properly logged. Children’s roster was reviewed and will be maintained as required.
Applicant has Mandated Reporter Training on file. Applicant’s CPR and First Aid is current. Applicant has completed 16 hours preventative health practices training.
Applicant was reminded 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.

Applicant was informed about the Provider Information Notices (PINs) on CCLD website.
Applicant was informed about Mandated Reporter Training available on CCLD website. Training is valid for two years.
(www.ccld.ca.gov or www.mandatedreporterca.com)

Applicant was informed 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, 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 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 [applicant, licensee, or facility representative] 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.


Report Continues......
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SHU, CHUNHUA
FACILITY NUMBER: 384004755
VISIT DATE: 08/18/2023
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
26
27
28
29
30
31
32
Page 3
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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
LPA reviewed with applicant LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
Report Continues

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/inspection-process.

Exit interview conducted and report was reviewed with the applicant, Chunhua Shu.

The following corrections will be necessary before a license to operate a small family child care license can be recommended:
- Fingerprint Clearance for all adults on lease.
- Licensee must complete move into the home.

This report and appeal were discussed with Applicant.
For additional questions please call: San Bruno Child Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or the Centralized Complaint and Information Bureau at 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3