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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384005049
Report Date: 07/17/2026
Date Signed: 07/17/2026 10:27:15 AM

Document Has Been Signed on 07/17/2026 10:27 AM - 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:CHEN, MING YIFACILITY NUMBER:
384005049
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
07/17/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:MIng Yi ChengTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
NARRATIVE
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On July 17, 2026 at approximately 8:30 AM, Licensing Program Analyst (LPA) Tso conducted an unannounced Case Management-Licensee Initiated Visit for capacity change. LPA met with licensee, Ming Yi Chen. The purpose of the inspection was explained, and LPA is allowed entry by licensee. This inspection is due to the Applications for Capacity Change and change the daycare areas from upper level to lower level that received in the Regional Office. The facility is going from a small license to a large license allowing a maximum of 14 children. Present in the home is licensee caring for 7 children in care (1 infant, 5 preschoolers and 1 school aged child).

DAY CARE AREAS are located on living room, bedroom # 2 (not in use because of installation air-conditioning device), the full bathroom on the upper level.

OFF LIMIT AREAS are the primary bedroom # 1, bedroom # 3, kitchen, and dining room on the upper level, and the entire lower level, including bedroom # 4, porch, garage, driveway and backyard. The off-limits areas are properly barricaded with child safety gates and/or closed doors. The days and hours of operation are Monday – Friday, 7:30 AM to 6:00 PM.

With licensee, LPA inspected the home for Health and Safety Hazards. LPA observed the followings: Day-care area is clean and equipped with age-appropriate toys and equipment for the children. The home has sufficient lighting and ventilation. The home has a working telephone, working smoke and carbon monoxide detector, and a fully charged fire extinguisher (3A40BC). The home is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. There are no bodies of water observed at the property. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. Per the licensee, there is reportedly no firearms or other weapons in the home. The Licensee plans to use hallway to isolate the sick children to wait for the parents to pick up. The Licensee plans to have all required posting on the right wall of the hallway of the main entrance. (Continued on page 2, …)

Garfield Leung
Man Tso
DATE: 07/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2026
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: CHEN, MING YI
FACILITY NUMBER: 384005049
VISIT DATE: 07/17/2026
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(Continued, page 2 …)
The licensee’s Pediatric First Aid and CPR is current and will expire in 05/2027. The licensee has current Mandated Reporter training and will expire in 05/2028.

LPA discussed the capacity requirements with licensee. Licensee understands that care cannot be provided for more than the capacity as stated on the license.

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.

The licensee 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 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 14 children.


LPA 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. LPA also informed licensee [or facility representative] 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.

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/.

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. (Continued on page 3, …)

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Man Tso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026
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: CHEN, MING YI
FACILITY NUMBER: 384005049
VISIT DATE: 07/17/2026
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(Continued, page 3 …)

Facility has obtained the Fire Clearance from the San Francisco Fire Department on 06/04/2026.

Large Family Child Care Home License and moving the day care areas from upper level to lower level are recommended and approved on 07/20/2026. From 07/20/2026, the upper level would be turned into off-limits areas. However, the Porch needed to be fixed. It is still the off-limits areas until providing the proof of fixing the following.

- Proof of barricaded or covered with cushion materials or removal of the lower wall mounted shelf on the right wall in the Porch.


The updated daycare and off-limits areas are as follows;
The DAY CARE AREAS are the Room # 1, Bathroom #1 and Hallway on the lower level.

The OFF-LIMITS AREAS are the Entire Upper Level including bathroom #2, # 3 & #4, kitchen, Living Room, Dining Room, garage, porch (needed to fix to be licensure as on-limits (Daycare) areas) and driveway/backyard on the lower level.



Exit interview conducted and report was reviewed with the licensee Ming Yi Chen. During the exit interview, the LICENSEE, Ming Yi Chen, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report was left with the Licensee, Ming Yi Chen whose signature on this form confirms receipt of reports. Notice of Site Visit was provided to licensee. The licensee was advised Notice of Site Visit to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Man Tso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026
LIC809 (FAS) - (06/04)
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