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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004968
Report Date: 10/02/2025
Date Signed: 10/02/2025 04:00:24 PM

Document Has Been Signed on 10/02/2025 04:00 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:MA, HUIYIFACILITY NUMBER:
384004968
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
10/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Huiyi MaTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
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On October 2, 2025 at approximately 2:35pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection in conjunction with an unannounced, case management visit. LPA met with licensee, Huiyi "Jannie" Ma, and explained the purpose of the visit. Present during LPA's visit included 2 infants. Licensee is operating within capacity limits and ratio during LPA's visit.

Licensee is currently licensed for a small family child care home. Licensee submitted a capacity increase application to department September 15, 2025. A fire clearance was received September 19, 2025.

Hours of operation are Monday through Saturday 7:00am to 7:00pm. Licensee lives in the multi-level home with their roommate. Adults living in the home have fingerprint clearance on file. Per licensee, their roommate may move out of the home.

Licensee operates home as a Chinese immersion program. The DAY CARE AREAS are the living room, kitchen (hand washing only), and bathroom (located on the second floor). The OFF LIMIT AREAS are the two bedrooms on the second level of the home. There are stairs in the home with child safety gates installed at both the top of the stairs and the bottom of the stairs. Off limit areas are made inaccessible with child safety door handles and/or child safety gates. Licensee was informed off limit areas cannot be used as a day care area without prior approval from the department. There is a shared, open outdoor area that is not for licensee's exclusive use, but shared with the neighborhood. LPA did not observe any pools, spas or bodies of water on site.

With licensee, LPA inspected day care areas for health and safety hazards. Home is clean and organized. LPA observed electrical outlets to be made inaccessible to children. Flooring in main day care areas include soft padding that is clean and free of stains. Furniture for children's use is age appropriate and also in good condition. LPA observed corners of shelves to have padding installed. There are a variety of toys and materials for children's use that are clean and in good condition. Per licensee, toys and materials are sanitized daily. LPA observed cabinets and drawers in day care areas to have child safety locks installed.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2025
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
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: MA, HUIYI
FACILITY NUMBER: 384004968
VISIT DATE: 10/02/2025
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LPA observed poisons, cleaning solutions and chemicals to be stored behind child safety locked cabinets and/or home's high shelves. Per licensee, children currently enrolled do not use the bathroom and are in diapers. LPA observed bathroom for children's use to be in working condition. Diapers and wipes are provided by children's families. Licensee maintains a cubby shelf in the home, storing children's personal belongings individually and appropriately. LPA observed home to have garbage bins with tight fitting lids.

Licensee provides a food service for children who are over 12 months old. Food service includes morning snack, lunch and afternoon snack. Reusable dishes are utilized and sanitized daily. Children under 12 months bring their own food that is stored in licensee's home. LPA observed food brought from home to be stored appropriately in licensee's refrigerator, labeled with the child's name.

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/.

Children sleep in the living room. LPA observed infant sleeping in a pack and play crib. LPA observed crib to be free of loose articles, materials and objects. Crib does not block or hinder entrance or exit to home. LPA observed infant able to climb out of a crib to be sleeping on a floor mat. LPA observed floor mat to be stored appropriately when not in use.

Licensee maintains sleeping logs for napping infants. LPA observed random selection of sleeping logs from the months of July, August and September 2025. LPA observed sleeping logs document every 10-15 minutes of when the napping infant is checked on while sleeping and licensee's initials.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA 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.

Licensing documentation is properly posted and made available for review. A childcare roster was also made available for LPA's review. Emergency disaster drills are conducted. Last disaster drill was conducted 8/7/2025. Home is equipped with a fire alarm system, smoke detectors, a carbon monoxide detector and fully charged fire extinguisher.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
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: MA, HUIYI
FACILITY NUMBER: 384004968
VISIT DATE: 10/02/2025
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LPA reviewed facility records that included all enrolled children's records and licensee's record. Children's records are complete with immunization records, emergency contact information and individual infant sleeping habits forms. Licensee's CPR certificate will expire 3/2027. Licensee's Mandated Reporter certificate is also current that will expire 3/2027. Licensee also maintains their required immunizations that were made available for LPA's review. Per licensee, there are no weapons of firearms in the home.

Capacity limits and ratios for a large family day care have been reviewed with licensee on this date. LPA reminded licensee that an assistant must be present when operating with a large capacity. LPA reminded licensee when there is no assistant present, licensee must operate within capacity limits of a small license.

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.

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.

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.

During the exit interview, the licensee, Huiyi Ma, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA will approve for a large license, capacity of 12 children, effective today's date.

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, Huiyi Ma.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4