384004799-11-12-2024-05-CC-BVAN-DAY2V4-20241112164319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004799
Report Date: 11/12/2024
Date Signed: 11/12/2024 04:45:38 PM

Document Has Been Signed on 11/12/2024 04:45 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/ DIRECTOR:	CHEN, MIAOXIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 741-8995
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 9	DATE:	11/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:10 PM
MET WITH:	MiaoLing Liu, Wu XiuLing, MiaoXin Chen		TIME VISIT/ INSPECTION 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 12, 2024, Licensing Program Analyst (LPA) Van conducted an annual random inspection and met the Licensee’s assistant, MiaoLing Liu. LPA explained the purpose of the inspection to the assistant, who was given access to the home. The assistant explained that the licensee had a doctor's appointment and was not home. The assistant supervised nine children alone (6 preschoolers and 3 infants). The facility does not comply with licensing capacity and limitations today, as stated in section 102416.5(e). If no assistant provider is present at a Large Family Childcare Home, then the licensee/facility shall comply with the capacity requirements for a Small Family Childcare Home. All staff present during the inspection have had their criminal record clearance verified with the CDSS Background Check System, and they are found to have eligible clearance status on file. The licensee came home during the visit, and her adult daughter, WuXiu Ling, also arrived. The previously approved childcare areas remained the same. Childcare areas: On the second level, the living room, dining room, 1/2 kitchen, bathroom, ground floor, and 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. LPA reminded the licensee to install baby gates in all off-limit areas as recommended during the initial pre-licensing inspection. The licensee stated she had already ordered the baby gates and would install them once they arrived. Additionally, all off-limit door needs to have child-proof door knobs or door handles installed. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

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 11/12/2024 04:45 PM - It Cannot Be Edited

Created By: Brendon Van On 11/12/2024 at 03:38 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: CHEN, MIAOXIN	FACILITY NUMBER: 384004799
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the Licensee did not comply with the section cited above. Upon entering the home, LPA observed that the licensee's assistant supervised nine children alone while the licensee was not home. The Licensee did not follow her license limitations, which pose an immediate health, safety, or personal rights risk to persons in care.
	POC Due Date: 11/13/2024
	Plan of Correction
1 2 3 4	The Licensees must adhere to their License's limitations and requirements. When the assistant is left alone, the Licensees shall comply with the capacity requirements for a Small Family Childcare Home. The licensee will create a written plan and submit it to the LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

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: CHEN, MIAOXIN	FACILITY NUMBER: 384004799
	VISIT DATE: 11/12/2024

NARRATIVE

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LPA inspected the childcare areas for any potential dangers to health and safety hazards. The childcare areas were clean and organized. The facility has age-appropriate books and activities to help children learn and play. The areas also had good heating, lighting, and ventilation, and no potential hazards posed any risk to children. The house has multiple smoke detectors, a carbon monoxide detector, and a fully charged fire extinguisher with a minimum standard specification of 2A 10 BC. Fully stocked first aid supplies are available for children. According to the Licensee, there are no firearms or weapons. No pools, spas, or bodies of water were on the premises. LPA did not observe walkers, bouncers, or similar items in the home. Licensees acknowledged that smoking is prohibited in family childcare homes.

LPA observed cleaning products, including Lysol and disinfectant spray, were found in the children's bathroom. The licensee's daughter explained that they had used these products to clean the bathroom over the weekend and forgot to put them away in the off-limit areas. These items were promptly removed and safely stored in the designated off-limit garage.

LPA noticed a crib in the nap room/activity room. The crib was observed to be free of toys, blankets, or pillows inside. The mattress fit its dimensions, and the bedsheets were snugly secured. The 15-minute sleep logs for infants were checked, and it was noted that the licensee had accurately documented the logs, including the date, time, and staff initials.

LPA discussed and informed the Licensee that she must be present at home to ensure that the children in her care are always supervised. When the licensee must be absent from the house, the temporary absence should not exceed 20 percent of the hours the facility provides care per day.

During the visit, LPA reviewed the records for both children and personnel. The licensee consistently keeps accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. The licensee and assistant have maintained records of all essential licensing requirements, such as necessary immunizations, valid Pediatric First Aid CPR certifications, and up-to-date mandated reporter training.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC809 (FAS) - (06/04)

Page: 3 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: CHEN, MIAOXIN	FACILITY NUMBER: 384004799
	VISIT DATE: 11/12/2024

NARRATIVE

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All the required licensing postings were observed posted. According to the licensee, regular fire and earthquake drills are conducted at least once every six months, with the most recent drills completed on 7/16/2024.

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.

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.

LPA discussed the safe sleep regulations with the Licensees 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 Licensee 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.

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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

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: CHEN, MIAOXIN	FACILITY NUMBER: 384004799
	VISIT DATE: 11/12/2024

NARRATIVE

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LPA reviewed AB 1207 with the Licensees. 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 child care 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, MIAOXIN CHEN, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

See LIC 809D for type A deficiency cited today.

A Type “A” violation was issued today. The licensee is informed to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files.

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, MiaoXin Chen.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC809 (FAS) - (06/04)

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