384004799-11-16-2023-05-CC-BVAN-CXN2W3-20231116164452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004799
Report Date: 11/16/2023
Date Signed: 11/16/2023 04:44:58 PM

Document Has Been Signed on 11/16/2023 04:44 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:	CHEN, MIAOXIN		FACILITY NUMBER:	384004799
ADMINISTRATOR:	CHEN, MIAOXIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 741-8995
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	11/16/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	MiaoXin Chen and Wu XiuLing		TIME COMPLETED:	05:00 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 November 16, 2023, Licensing Program Analyst (LPA) Van met with the Applicant, MiaoXin Chen, and her adult daughter, Wu XiuLing, who provided Cantonese translation for an announced pre-licensing inspection. The applicant rents these two levels home, consisting of five bedrooms and three baths. The loft has two bedrooms and a bath, the second level has two bedrooms, a kitchen, and a bathroom, and the lower floor has a bedroom and a split bath. The home's resident are the applicant and granddaughter. Childcare areas: On the second level, living room, dining room, 1/2 kitchen, bathroom; Ground floor; bedroom #1, the applicant called the activity room. OFF-limit areas: the loft, two bedrooms on the second level, and the lower level, including the laundry room, sauna room, backyard, the other ½ of the kitchen where stoves are located, and garage. The days and hours of operation will be Monday - Friday, 6:00 am to 6:00 pm, and care for children between newborn to 6 years old. Per the Applicant, she plans to utilize the dining room as an isolation for sick/ill children. The main gate will be designated as a pick-up and drop-off location. The LPA and the Applicant thoroughly inspected the entire home to ensure no Health and Safety Hazards. LPA found that all furniture and playthings were in great condition and well-maintained. The fireplace was properly barricaded with a screen for added safety. Additionally, the home had multiple smoke detectors, a carbon monoxide detector, and a fully charged 3A40BC fire extinguisher that were all in good working condition. During the inspection, LPA tested the smoke and carbon monoxide detectors, which worked. All harmful objects, sharp objects, and toxins were stored out of the reach of children and inaccessible to them. The bathroom was clean and hygienic. The Applicant confirmed that there were no weapons or firearms in the home. Furthermore, all electrical outlets had plastic covers, and there was no body of water on the property, such as a swimming pool, spa, hot tub, or fishpond. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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: CHEN, MIAOXIN	FACILITY NUMBER: 384004799
	VISIT DATE: 11/16/2023

NARRATIVE

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LPA informed the Applicant that emergency drills are required every six months, and the Applicant must document the drills. The Applicant reminded that NO baby walkers, exer-saucers, jumpers, bouncers, and similar items are to be used for children in care and should be made inaccessible. In addition, booster chairs are only used for the purpose of feeding/eating. The Applicant was also reminded that smoking is prohibited at the daycare.

The Applicant plans to provide the children with breakfast, lunch, and snacks. Per the Applicant, she intends to purchase liability insurance for childcare. LPA informed the Applicant that if childcare insurance is not purchased, each parent must be given the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Applicant's Pediatric FirstAid CPR and Mandated Reporter Training are valid, and copies have been submitted to the Department.

LPA reviewed with the Applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children's forms/records, facility forms/records, and all required postings such as License/Parent's Right poster/Emergency Disaster Plan and Earthquake Preparedness checklist. In addition, the entrance Checklist was also provided to the Applicant. License capacity and limitation were also reviewed with the Applicant. LPA informed the Applicant that if care is provided to the 7th and 8th child, who must be school-aged, parent notification and landlord consent are required.

LPA discussed the safe sleep regulations with the Applicant 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 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: CHEN, MIAOXIN	FACILITY NUMBER: 384004799
	VISIT DATE: 11/16/2023

NARRATIVE

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The 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 the 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).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) 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.

The 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. The Applicant was encouraged to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. The Applicant was also reminded of Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, and both are available on www.mandatedreporteca.com.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: CHEN, MIAOXIN	FACILITY NUMBER: 384004799
	VISIT DATE: 11/16/2023

NARRATIVE

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On this date, 11/16/2023, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders through 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.

The applicant 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.

Prior to licensure, the following issue must be addressed.
· Install a barricade/baby gate at the bottom stair by the entrance.
· Install a baby gate to prevent children from accessing the other half of the kitchen.
· Criminal record clearance for all adults residing at the home.
· Fire clearance approval by the Fire Department

The Applicant, MiaoXin Chen (the Licensee’s daughter, Wu XiuLing, who translated the report) reviewed and signed the report. Today's report was provided to the Applicant. This report will be kept in the facility file and available for public review upon request. Desk duty is available Monday - Friday, 8:00 a.m. – 5:00 p.m. (650) 266-8800. Website for Forms and Regulations: www.cdss.ca.gov

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC809 (FAS) - (06/04)

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