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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004755
Report Date: 10/23/2024
Date Signed: 10/23/2024 01:59:23 PM

Document Has Been Signed on 10/23/2024 01:59 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SHU, CHUNHUAFACILITY NUMBER:
384004755
ADMINISTRATOR/
DIRECTOR:		SHU, CHUNHUAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 676-8718
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:47 PM
MET WITH:Chunhua ShuTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On October 23, 2024 at approximately 12:35pm, Licensing Program Analysts (LPA) Tso met with the licensee, Chunhua Shu for an unannounced complaint investigation, and inspection of the Plan of Correction (POC). The purpose of the inspection was explained, and the Licensee granted LPA entry to the home. There were four infants in care with the licensee.

During the complaint investigation on October 10, 2024, the Licensee received a citation for deficiency. The Type A was cited deficiency due to the licensee did not comply with the Staffing Ratio and Capacity regulations that 5 infants present. It was overcapacity of number of infants in care.

During today's inspection, LPA observed there were 4 infants that no overcapacity was found. LPA observed the Notice of Site Visit posted and LIC9224 Acknowledge Receipt of Licensing Reports were signed by all parents of the children in care.

Deficiencies cited on October 10, 2024, were cleared today. Plan of Correction letter was provided to the Licensee.

There were no deficiencies cited at this time under CCR, Title 22, Div. 12. A copy of today’s report was given to the licensee.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted with the Licensee, Chunhua Shu.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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