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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004878
Report Date: 06/10/2025
Date Signed: 06/10/2025 04:20:26 PM

Document Has Been Signed on 06/10/2025 04:20 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:CHINESE AMERICAN INTERNATIONAL SCHOOLFACILITY NUMBER:
384004878
ADMINISTRATOR/
DIRECTOR:		CHU HSI TSENGFACILITY TYPE:
860
ADDRESS:3250 19TH AVENUETELEPHONE:
(415) 865-6088
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 120TOTAL ENROLLED CHILDREN: 104CENSUS: 97DATE:
06/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Chu Hsi Tseng & Agnes TongTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On June 10, 2025 at approximately 8:35am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management visit in conjunction with an annual inspection. LPA met with preschool director, Chu Hsi Tseng, and explained the purpose of the visit. At start of LPA's visit, children were arriving to facility.

Hours of operation are Monday through Friday, 9:00am to 3:30pm. Morning and afternoon hours are available for preschool children from 7:45am to 6:00pm. Preschool program is licensed to operate in 6 classrooms: Preschool 2 Blue Classroom (#107), Preschool 2 Purple Classroom (#109), Preschool 3/4 Orange Classroom (#111), Preschool 3/4 Green Classroom (#123), Preschool 3/4 Red Classroom (#127), and Preschool 3/4 Gold Classroom (#130). Preschool program is also licensed to utilize the multi-purpose space (#131).

Associate preschool director, Agnes Tong, requested to add the Tinker Space (#104) and the dance studio for preschool children. Capacity will remain 120 preschool children. Facility received a fire inspection on May 27, 2025. Associate preschool director provided LPA with fire clearance. LPA informed preschool director that the fire department must send fire clearance to licensing department directly.

Tinker space will be utilized as an art classroom while the dance studio will be utilized as multi-purpose space for music and preschool theater. LPA inspected spaces to be added for health and safety hazards, and measured spaces to calculate capacity.

The Tinker Space was measured for 744.26 sq. ft. allowing for a capacity of 21 children. LPA observed the Tinker Space to have sufficient materials and furniture. LPA observed materials and furniture to be age appropriate. There is a carpet in the classroom that was observed to be clean, free of stains. LPA observed electrical outlets to be made inaccessible with child safety covers. There is an accessible sink and water fountain to children, if needed. LPA observed cabinet under children's sink to have a child safety lock installed. There is also an adult sink for staffs' use.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHINESE AMERICAN INTERNATIONAL SCHOOL
FACILITY NUMBER: 384004878
VISIT DATE: 06/10/2025
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There is a wood working table in the Tinker Space. LPA advised preschool director to remove handle on wood working table. LPA observed classroom to be equipped with fire sprinklers. Per facilities director, entire facility includes hard wired smoke and carbon monoxide detectors. Per facilities director, if carbon monoxide levels are high, a notice is sent to staff via an electronic application. Per facilities director, hard wire system automatically pumps air into classrooms if carbon monoxide levels are high.

Preschool director plans for the dance studio to be an indoor activity space for preschool children that includes music class and performing arts (theater) only. Dance studio measured for 2,045.59 sq. ft. allowing for a capacity of 58 children. LPA observed dance studio to include a variety of music materials. There is a storage cabinet that is secured to the wall. There is also a storage area in the studio that is separated from the activity space with multiple wall partitions. LPA discussed with preschool director that if dance studio is utilized for physical education or as an alternate outdoor activity space, dance studio must be measured as an outdoor multi-purpose space.

At approximately 9:30am, associate preschool director, Agnes Tong, arrived to facility. LPA conducted visit with both preschool director and associate preschool director.

For the annual inspection, LPA inspected preschool areas for health and safety hazards. Present during LPA's visit included 97 preschool children and 20 preschool teaching staff. Preschool program is operating within capacity limits and ratio. Preschool teaching staff have fingerprint clearance on file.

LPA observed classrooms to be equipped with a variety of children's toys and materials that are in good condition. Per associate preschool director, toys and materials are sanitized weekly or monthly. Classrooms include activities for manipulatives, building, arts and crafts, and quiet areas. LPA observed cleaning solutions and chemicals to be made inaccessible in classrooms, stored behind child safety locked cabinets and/or stored in classrooms' high shelves. LPA also observed cabinets and drawers in classrooms to either be locked or have child safety locks installed.

There are rugs in each classroom. Per associate preschool director, rugs are shampooed monthly while the floor is sanitized multiple times a day. Storage for children's belongings are located inside each classroom. LPA observed children's cubbies to be labeled with their individual names and pictures.

Children sleep in each classroom on floor mats, also labeled with children's individual names. LPA observed children's mats to be stored appropriately in each classroom, so that they are not touching each other. Sheets and blankets are provided by the preschool program that are laundered on site weekly. Children are able to bring their own blankets that are sent home weekly to be laundered.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHINESE AMERICAN INTERNATIONAL SCHOOL
FACILITY NUMBER: 384004878
VISIT DATE: 06/10/2025
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LPA observed facility to be equipped with multiple fully charged fire extinguishers. LPA also observed each classroom to include an emergency backpack with emergency contact information, emergency supplies and first aid equipment. Each classroom includes a designated first aid cabinet that includes emergency medication. LPA observed children's medication to also be posted in each classroom.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters/.

There are two outdoor areas for preschool children's use, located in the front of the facility. LPA observed outdoor area to be fully enclosed and fenced. There are a variety of outdoor toys and materials that are in good condition. Flooring in outdoor area includes resilient padding. There are sand boxes in the outdoor area. Per preschool director, sandbox is cleaned daily prior to children's use. LPA did not observe any pools, spas or bodies of water on site.

Drinking water is available both in doors and outdoors with children's individual water bottles or accessible drinking fountains. LPA observed children's individual water bottles to be labeled with their names and can be refilled on site through accessible water fountains in each classroom.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Restroom for preschool children's use is located in each preschool classroom. LPA observed restrooms to be in working condition and equipped with appropriate sanitation materials. Diaper changing tables are available in restrooms, if needed. LPA observed diaper changing tables to be within arm's reach to an adult sink. Diapers and wipes are provided by children's families and stored appropriately. LPA observed diapers and wipes to be labeled with children's individual names. Garbage bins in children's restrooms and classrooms include tight fitting lids.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHINESE AMERICAN INTERNATIONAL SCHOOL
FACILITY NUMBER: 384004878
VISIT DATE: 06/10/2025
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Program provides a food service that includes snack only. Children's families provide lunch daily. Food is prepared and served in each classroom. LPA observed knives to be stored behind child safety locked cabinets and stored in classrooms' high shelves. Both reusable and disposable utensils are utilized for children. Reusable utensils are sanitized daily in facility's dishwasher. LPA did not observe cleaning solutions and snacks to be stored near food items served to children.

Children are signed into and out of program with authorized representatives' electronic signatures. Each authorized representative has a unique code that is specific to the individual. Written sign in/out sheets are available on site, if needed. Licensing documents are properly posted and available for review. Emergency disaster drills are conducted bi-monthly and are documented. Last disaster drill conducted was 6/4/2025.

LPA reviewed 10 random children's records. Children's records are complete with emergency contact information. A child care roster is posted in each classroom. LPA reviewed random teaching staffs' files. Multiple teaching staff on site have a current CPR/First Aid certifications, current Mandated Reporter certifications, and required immunizations available for review.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

Director was informed of the MyChildCarePlan.org website; 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.

Lead testing was conducted on today's date. A Type B citation is being issued for lead testing being conducted past the 180 days within licensure. Please refer to 9099D for more information. A plan of correction was discussed. Appeal rights were provided.

LPA will approve for room addition of Tinker Space (#104) and the dance studio when lead testing is completed within department's written directives.

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

Exit interview conducted and report was reviewed with facility representative, Chu Hsi Tseng.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/10/2025 04:20 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 06/10/2025 at 02:49 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: CHINESE AMERICAN INTERNATIONAL SCHOOL
FACILITY NUMBER: 384004878

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
WD
101700(b)
Written Directives for Lead Testing
(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure. Facility conducted lead water testing on June 10, 2025, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2025
Plan of Correction
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Facility conducted lead water testing on June 10, 2025. Lead testing results shall be posted per department's written directives. Childcare Center Sampling Checklist (LIC9276) was provided to LPA during today's visit. Facility sketch (LIC999) labeling water fixtures tested and External Water Sampler Self-Certification Form (LIC9275) shall also be submitted to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
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