<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004931
Report Date: 12/16/2024
Date Signed: 12/16/2024 05:12:35 PM

Document Has Been Signed on 12/16/2024 05:12 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:NERGUI, AMARJARGALFACILITY NUMBER:
384004931
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:22 PM
MET WITH:Amarjargal NerguiTIME VISIT/
INSPECTION COMPLETED:
05:30 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 December 16, 2024, at approximately 1.30pm, Licensing Program Analyst (LPA) Tso met with the Applicant, Amarjargal Nergui, for an announced pre-licensing inspection. The applicant and her spouse were present at the home. The applicant rents this two-floor apartment unit, consisting of one bedroom, two bathrooms, living room, family room, a kid’s room, kitchen with dining area, laundry room on the second floor, and garage and backyard on the ground floor. (Note: there is three floors building. #512 is consisting of the separate part of the second floor and ground floor with the garage and backyard, while #510 is consisting of the separate part of second floor and the third floor.) The home residents are the applicant and spouse. The childcare area will be provided in the living room (playing area), family room (napping area), kid’s room (diaper changing and napping), and 2 bathrooms #1 & #2, on the second floor. The off-limit areas are the bedroom #1, kitchen with dining area, entrance hallway to the kitchen with dining area, laundry room on the second floor, and garage and backyard on the ground floor. The applicant states that this is their primary residence where they live full time. The days and hours of operation will be Monday - Friday, 7:30 am to 5:30 pm, and care for children between 2 months old to below fourteen years old. Per the Applicant, she plans to utilize the kid’s room as an isolation for sick/ill children.

LPA and the Applicant inspected the entire home for Health and Safety Hazards. The house is clean and orderly and has sufficient lighting and ventilation. LPA observed a changing mattress in the kid’s room. Also observed two cribs in the family room and kid’s room respectively. LPA observed the windows at the living are installed 2 feet high fences from the bottom of the window. The heater in front of the fireplace at the living room was observed barricaded with a child safety gate. LPA reminded the applicant to keep playpens and/or cribs free of toys, pillows, and hanging objects. Mattresses must be designed for playpens and/or cribs, and bed sheets should fit tightly. There are a variety of age-appropriate toys but insufficient for the children. All furniture and playthings were observed to be in good repair.
(Continued on page 2...)
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NERGUI, AMARJARGAL
FACILITY NUMBER: 384004931
VISIT DATE: 12/16/2024
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
26
27
28
29
30
31
32
(Continued, page 2…)
The home has a smoke detector only. The licensee would change to a combination of smoke & carbon monoxide detector. All harmful objects, sharp objects, and toxins are stored out of the reach of children and made inaccessible to children, except in the bathroom’s lower cabinet. The Applicant states that no weapons, firearms, or pets are in the home. The home has no body of water, such as a swimming pool, spa, hot tub, or fishpond. All unused electrical outlets and electrical wires/power surges were observed covered.

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 breakfast, morning snacks, lunch, and afternoon snacks. Per the Applicant, she does not plan 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 and 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. The Applicant plans to have all required posting on the right wall by the main entrance. 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.
(Continued on page 3...)
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NERGUI, AMARJARGAL
FACILITY NUMBER: 384004931
VISIT DATE: 12/16/2024
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
26
27
28
29
30
31
32
(Continued, page 3…)
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 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 has obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

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.
(Continued on page 4...)
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NERGUI, AMARJARGAL
FACILITY NUMBER: 384004931
VISIT DATE: 12/16/2024
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
26
27
28
29
30
31
32
(Continued, page 4...)
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.

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 recommended for licensure, the applicant must complete the following for review:
- Proof of installation of child safety locks for the low cabinet at bathroom # 2.
- Proof of installation of workable smoke and carbon monoxide detectors
- Proof of availability of thermometer.
- Proof of availability of age-appropriate toys, books, and furniture such as table, chairs, etc. for
eating, drawing, etc.
- Proof of availability of mattress for preschool aged children napping.

The report was reviewed and signed by the Applicant, Amarjargal Nergui. 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: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4