384004968-12-19-2024-05-CC-BVAN-DC4S8Z-20241219123959

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004968
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:40:14 PM

Document Has Been Signed on 12/19/2024 12:40 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:	MA, HUIYI		FACILITY NUMBER:	384004968
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/19/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Ma HuiYi		TIME VISIT/ INSPECTION COMPLETED:	12:45 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 19, 2024, Licensing Program Analyst (LPA) Van conducted a scheduled pre-licensing inspection with the applicant, HuiYi Ma. Only the applicant and no children were present during the inspection. The applicant rents this two-floor townhouse, consisting of two bedrooms, a bathroom on the second floor, a living room, a dining area, and a kitchen on the ground floor. The home residents are the applicant and a roommate. Childcare will be provided in the living room, dining area on the first floor, and bathroom on the second floor. The off-limit areas will be the two bedrooms on the second floor. The days and hours of operation will be Monday - Saturday, 7:00 am to 7:00 pm, and care for children between four months to 1^st grade. Per the Applicant, she plans to utilize the dining area as an isolation for sick/ill children. LPA and the applicant thoroughly examined the home for potential health and safety hazards. All furniture and toys were found to be in good condition. There were cubbies for children's belongings and various imaginative and role-playing toys. LPA noticed a play yard set up in the living room, complete with a baby mobile hanging overhead. LPA reminded the applicant that items such as toys, pillows, blankets, sleep sacks, and baby mobiles should not be present in the play yard. The applicant quickly acted and removed the mobile. A complete first aid kit is readily available. The home is equipped with a combination of smoke alarm and carbon monoxide detector, which have been tested and found to be operational. All cleaning products and disinfectants were observed stored in a closet with a child-proof magnetic lock. Unused electrical outlets were appropriately covered. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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 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: MA, HUIYI	FACILITY NUMBER: 384004968
	VISIT DATE: 12/19/2024

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 from page 1...
No fireplace was observed in the living room. The applicant has a fully charged fire extinguisher with specifications of 3A 40 BC. According to the applicant, no guns or weapons are in the home, and no dogs or cats are present. Additionally, the applicant confirmed no bodies of water, such as swimming pools, spas, hot tubs, or fishponds, are on the premises.

LPA reviewed and informed the Applicant about the importance of conducting emergency drills every six months. The Applicant was reminded to document these drills. Additionally, the Applicant was advised not to use baby walkers, exer-saucers, jumpers, bouncers, and similar items for children in care. It was also emphasized that these items should be made inaccessible. The Applicant was informed that booster chairs are only for feeding/eating purposes. Furthermore, the Applicant was reminded that the daycare strictly prohibits smoking.

The Applicant mentioned plans to provide the children with breakfast, lunch, and am and pm snacks.

According to the Applicant, she plans 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 Childcare Home (LIC 282). The applicant's Pediatric First Aid 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. License capacity and limitation were also reviewed with the Applicant. LPAs 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: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

Page: 2 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: MA, HUIYI	FACILITY NUMBER: 384004968
	VISIT DATE: 12/19/2024

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 from page 2...
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 provided proof of control of the property.

The applicant has not 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

Continued on page 4...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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: MA, HUIYI	FACILITY NUMBER: 384004968
	VISIT DATE: 12/19/2024

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 from page 3...
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 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, both of which are available on www.mandatedreporteca.com.

On this date, 11/18/2024, 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.

Continued on page 5...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

Page: 4 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: MA, HUIYI	FACILITY NUMBER: 384004968
	VISIT DATE: 12/19/2024

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

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 licensure, the following issue must be addressed.
· Install two window stoppers for two large sliding windows in the living room.
· Install anti-slip strips for stairs leading to the bathroom.

An exit interview was conducted, and the report was reviewed with the applicant, HuiYi Ma.

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: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5