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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004880
Report Date: 04/02/2025
Date Signed: 04/02/2025 03:08:09 PM

Document Has Been Signed on 04/02/2025 03:08 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:ZHANG, NANCYFACILITY NUMBER:
384004880
ADMINISTRATOR/
DIRECTOR:		NANCY ZHANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 971-6888
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
04/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:51 AM
MET WITH:Nancy ZhangTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 4/2/2025, Licensing Program Analysts (LPAs) Leong and Wadhwa conducted an unannounced annual and case management visit regarding the use of Bedroom #2. LPAs met with Licensee Nancy Zhang and explained the purpose of the visit.

Present at today's visit were four children (two infants and two pre-k), the licensee, and an assistant. Both the licensee and the assistant have a criminal record clearance from the California Department of Social Services. The licensee holds a large license and is operating within the required capacity limits and ratios during this visit.

According to the licensee, five children are enrolled in her daycare. The children’s roster was not available for review. Therefore, the facility will receive a technical violation.

LPAs observed that all required documents, including the facility license, Notification of Parental Rights, and Earthquake Preparedness Checklist, were displayed on the bulletin board.

The most recent emergency disaster drill took place on 3/26/2025, and LPAs observed that it was documented. LPA reviewed the emergency disaster drill log and found it was conducted monthly.

LPAs inspected Bedroom #2, which was previously off-limits. LPAs observed Bedroom #2 to be clean, ventilated, and set up as a nap room. The room has children’s floor mats and is equipped with three cribs, a smoke detector, a changing table, and foam climbing toys. As of today, 4/2/2025, LPAs have approved the use of Bedroom #2 for daycare purposes.

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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
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: ZHANG, NANCY
FACILITY NUMBER: 384004880
VISIT DATE: 04/02/2025
NARRATIVE
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The new daycare areas are a living room, a dining room, bathroom #1, and bedroom #2.

The off-limit areas are bedrooms #1 and #3, the kitchen, and the backyard.

LPAs inspected the indoor daycare areas to identify health and safety hazards. The home is equipped with a fully functional fire extinguisher, a first aid kit, a carbon monoxide detector, and a smoke detector.

LPAs observed that the home's interior was clean and orderly. The rooms are well-lit and ventilated. Disinfectants, cleaning solutions, poisons, and other hazardous items were stored in areas inaccessible to children. The bathroom was clean, fully operational, and equipped with sanitation products.

The daycare areas have toys, furniture, and learning materials that are suitable for the children's ages. There is a designated area for storing children's clothes and personal items. Electrical outlets are equipped with child safety covers to protect children. The kitchen has a child safety gate to prevent children from entering. LPAs observed the wall heaters in the daycare areas were not covered. Therefore, technical assistance was issued to the facility.

The licensee said that there were no firearms or weapons on the property.

LPAs did not find any pools, spas, or other bodies of water on the property.

The licensee serves breakfast, lunch, and snacks to the children. The licensee reported that none of the enrolled children have documented allergies. Parents of children under one year old are required to provide their own milk or formula.

The facility offers different options for children to rest or nap, including cots and cribs. LPAs observed that blankets were available for the children. The families provide blankets for use, and they are sent home weekly to be laundered.

Infant mattresses are firm. All cribs are well-maintained and free of loose items that could pose safety risks. The sheets in the crib appeared loose, and the licensee removed them per LPA’s request. LPA’s advised the Licensee only to use fitted sheets for the mattresses in the crib.
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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
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: ZHANG, NANCY
FACILITY NUMBER: 384004880
VISIT DATE: 04/02/2025
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LPAs reviewed the files of four children and confirmed that they all had complete records. The children's files contain records of emergency identification information and necessary immunizations.

LPAs also reviewed the 15-minute sleep records for four children and confirmed they were documented.

LPAs reviewed the licensee’s and the assistant’s records and found the CPR & First Aid certificate and the Mandated Reporter Training certificate were current. LPAs found that MMR, Tdap, and TB records were missing in both files. Therefore, the facility will receive a technical violation.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs also informed 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 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.
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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: ZHANG, NANCY
FACILITY NUMBER: 384004880
VISIT DATE: 04/02/2025
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During the exit interview, the licensee, Nancy Zhang, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

TECHNICAL VIOLATION: Violations of the Health and Safety Code (HSC), regulations (CCR), or interim licensing standards (ILS) that do not pose a health, safety or personal rights risk.

No deficiencies were issued today during LPA's visit.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Nancy Zhang.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
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