384004902-9-20-2024-05-CC-BVAN-D9AVJY-20240920162930

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004902
Report Date: 09/20/2024
Date Signed: 09/20/2024 04:29:48 PM

Document Has Been Signed on 09/20/2024 04:29 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:	KUBOTA, JUN & NORIKO		FACILITY NUMBER:	384004902
ADMINISTRATOR/ DIRECTOR:	JUN & NORIKO KUBOTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 913-8695
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/20/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:20 PM
MET WITH:	Jun Kubota		TIME VISIT/ INSPECTION COMPLETED:	04:30 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 September 20, 2024, Licensing Program Analyst (LPA) Van conducted a scheduled pre-licensing relocation inspection and met with one of the licensees, Jun Kubota. The licensees have requested to relocate from the previous facility, #384002701, to the current location and increase the capacity from 8 to 14. During the inspection, no children were present. According to Mr. Jun Kubota, the children were in the care of his co-licensee, Noriko Kubota, at the #384002701 location. The licensees own this home, which has five bedrooms and three baths. The home's residents are licensees (husband and wife) and their minor son. The licensee plans to use only the ground-floor areas for childcare, which consist of the activities room, infant napping room, kitchenette, and backyard. The entire second and third floors of the home and the garage will be off-limits. LPA and the Licensee inspected the entire home for Health and Safety Hazards. The house is well-organized and clean and has sufficient lighting and air circulation. A fully charged fire extinguisher with the specification of 2A 10 BC. The licensee has installed several carbon monoxide and smoke detectors in the home. During the inspection, the carbon monoxide and smoke alarms were tested and found to be operational. All harmful, sharp, and toxic objects are stored in the second-floor kitchen cabinets. LPA noticed that the home is well-equipped with various toys and reading materials suitable for children of different ages. According to the licensee, the facility provides breakfast, lunch, and afternoon snacks to children. All food preparation will occur in the kitchen on the second floor. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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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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: KUBOTA, JUN & NORIKO	FACILITY NUMBER: 384004902
	VISIT DATE: 09/20/2024

NARRATIVE

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According to the Licensee, there are no guns or weapons on the premises, and no pets.

The backyard is fully fenced, and the licensee intends to use the entire space for children's activities. LPA reminded the licensee to trim all overgrown grass and ensure the grassy areas are hazardous and debris-free. Additionally, the licensee must install a baby gate at the bottom of the stairs to prevent children from accessing the second-floor deck.

LPA reviewed with the Licensee the LIC 311D, Forms/Records to Keep in Your Family Childcare Homes, children's forms/records, facility forms/records, and all required postings such as License/Parent's Rights poster/Emergency Disaster Plan and Earthquake Preparedness checklist. In addition, the entrance Checklist was also provided to the Licensee. License capacity and limitation were also reviewed with the Licensee. LPA informed the Licensee that if care is provided to the 13th and 14th child, who must be school-aged, parent notification is 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.

The Licensee 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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: KUBOTA, JUN & NORIKO	FACILITY NUMBER: 384004902
	VISIT DATE: 09/20/2024

NARRATIVE

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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 licensee 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 licensee was also reminded of the Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, both of which are available on www.mandatedreporteca.com.

On this date, 7/23/2024, 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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: KUBOTA, JUN & NORIKO	FACILITY NUMBER: 384004902
	VISIT DATE: 09/20/2024

NARRATIVE

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The licensee 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.

The San Francisco Fire Marshal granted fire clearance on August 1, 2024.

The licensee’s home will be recommended for a Large FCCH license once the following issues are addressed:

· Co-licensee Noriko Kubota must submit 8 hours of Preventive Health and Safety Training.
· The licensee must trim all overgrown grass and ensure the grassy areas are hazardous and debris-free.
· Licensees must install a baby gate at the bottom of the stairs to prevent children from accessing the second-floor deck.

The licensee expressed his intention to have all currently enrolled children move to the new location by October 1, 2024. LPA reminded the licensee to address the overgrown grass and install the baby gate before transitioning the children to this location. Additionally, until all three items mentioned above are addressed, the licensee must adhere to the capacity and limitation for small licenses.

An exit interview was conducted, and the report was reviewed with the co-licensee, Jun Kubota.

Today's report was provided to the licensee. 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: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC809 (FAS) - (06/04)

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