384004767-9-6-2023-05-CC-SLOO-CVEPU4-20230906113655

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004767
Report Date: 09/06/2023
Date Signed: 09/06/2023 11:37:32 AM

Document Has Been Signed on 09/06/2023 11:37 AM - 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:	XU, HUILING		FACILITY NUMBER:	384004767
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	09/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Huiling Xu		TIME COMPLETED:	11:39 AM

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On September 6, 2023, Licensing Program Analyst (LPA), Sheran Lo met with applicant Huiling Xu for a schedule pre-licensing inspection at the facility. Present is the applicant. Applicant owns the home, which is a two bedroom, one bathroom, two level home. Living in the home are applicant, husband, and child. Criminal record clearances are on file. Days and hours of operation are Monday - Friday, 8:00 AM. to 6:00 PM. Childcare Area: Living Room, Bathroom, Dining Room, and Backyard. Off-limit Area: All Bedrooms, Downstairs Living Room, and Kitchen. LPA inspected home with applicant for health and safety hazards.

The following was observed: Childcare area was clean and orderly with a variety of age appropriate wooden toys, books, and games for the children. Furniture and playthings inspected are new and in good condition. Bathroom, located through the hallway, is used for child care. The children’s mats and nap supplies were stored in the storage room. Shelves and hangers had been added to the facility for storage of children’s belongings. Playroom had two child size table and several chairs for meals and activities. Per applicant, children will be served meals in the playroom. Accessible cabinets and drawers in the kitchen and bathroom had child safety locks installed. Bathroom #1 was in operating condition with adequate supplies. The home had two large windows for ventilation and lighting. LPA observed all accessible electrical outlets, trash bins had been properly covered. Detergents and cleaning supplies were made inaccessible, stored under the kitchen sink and storage room. Facility has functioning cell phone, smoke/ carbon monoxide detector combo and fire extinguishers (2A:10:BC). Per applicant, there are no pets in the home.

Per applicant, there are no guns or weapons in the home. Bedrooms were free of hazards or dangerous conditions. Isolation area for an ill child will be in the playroom.

Applicant was informed that the Department must be notified that prior to use of any off-limits areas.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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: XU, HUILING	FACILITY NUMBER: 384004767
	VISIT DATE: 09/06/2023

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Licensing forms and posting requirements were reviewed with the applicant. LPA discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity.

Applicant stated they plans to provide food for the children. LPA reminded applicant that food brought from home should be properly labeled. Applicant understands that fire/earthquake drills are to be conducted every six months and recorded. Applicant understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited in family childcare homes. Applicant's CPR/1^st Aid certification was current, expiring: 10/2024. Mandated Reporter Training was current, expiring: 11/2024.

Applicant was reminded 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The applicant provided proof of control of property.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

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) or (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

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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: XU, HUILING	FACILITY NUMBER: 384004767
	VISIT DATE: 09/06/2023

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LPA reviewed with applicant the 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.

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 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.

On this date, 07/24/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given to applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the applicant Huiling Xu.

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 platforms.
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.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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