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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384005131
Report Date: 04/30/2026
Date Signed: 04/30/2026 12:16:52 PM

Document Has Been Signed on 04/30/2026 12:16 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:LITTLE PANDA CHILDREN'S CAMPFACILITY NUMBER:
384005131
ADMINISTRATOR/
DIRECTOR:		JIEMIN ZHANGFACILITY TYPE:
860
ADDRESS:1600 HOLLOWAY AVENUETELEPHONE:
(415) 516-8121
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 114TOTAL ENROLLED CHILDREN: 27CENSUS: 16DATE:
04/30/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Jiemin "Tiffany" ZhangTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On April 30, 2026 at approximately 8:40am, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, case management visit. LPA met with licensee/director, Jiemin Tiffany Zhang, and explained the purpose of the visit.

Facility is a single license with infant, toddler and preschool components. Infant component is licensed to operate in classrooms #118, 119, 120, and 121. Toddler component is licensed to operate in classroom #112. Preschool component is licensed to operate in classroom #114.

During today's visit, infant classroom #121 and preschool classroom #114 was in operation only. Present during LPA's visit included 16 children total with 5 teaching staff: 5 infants with 2 teaching staff and 11 preschool children with 3 teaching staff. Also present included 7 high school volunteers.

Case management visit is in regards to a self-reported incident that was reported to the department on April 20, 2026. Incident at facility had occurred April 16, 2026.

Per self-reported incident, Child 1 (C1) was climbing on a dome climbing structure in the preschool outdoor area. C1 slipped while climbing, fell through dome climbing structure face forwarded, and landed on C1's legs. C1 was assessed by teaching staff present, Teacher 1 (T1). Per director, C1 was not observed to have any redness, mark, bruise or swelling on C1's body. C1 was also observed to not be wearing closed toe shoes. Director provided C1 with an ice pack as C1 expressed discomfort in C1's shoulder.

Per director, C1's parents were informed of incident within approximately 3 minutes of incident occurring. Per director, C1's parent advised director to observe C1 for the time being. C1 remained at facility as per C1's normal. Approximately 30 minutes later, director contacted C1's parent a second time as C1 expressed discomfort again. C1 was picked up from facility as per C1's normal. Director met with C1's parent and further discussed incident.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2026
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 3
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: LITTLE PANDA CHILDREN'S CAMP
FACILITY NUMBER: 384005131
VISIT DATE: 04/30/2026
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From April 16 through today's date, C1 did not return to program. Director stated they were informed by C1's parent that child continued to have discomfort.

Director self reported incident to department on April 20, 2026. Documentation was also submitted.

On April 27, 2026, director was informed by C1's parent that C1 was then diagnosed with a fractured collarbone. Director has been unable to get in contact with C1's parent for additional details. As of this date, C1 has not returned to program.

During today's visit, LPA conducted an interview with director, obtained facility records, and inspected outdoor area. LPA observed dome climbing structure to be located in a sandpit with sand as resilient padding underneath. Per director, dome climbing structure has not been moved and is labeled for children ages 3 years old to 5 years old. All families were also informed for children to wear closed toe shoes to program.

LPA found the director to immediately notify a child's parent of an injury sustained. Staff provided child with first aid after injury. Director followed instructions from child's parent on action to be taken towards child. Director also self reported incident to department with documentation.

LPA found program to be within compliance of a child's health related services and within compliance of reporting requirements.

No deficiencies were issued during today'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, Jiemin Tiffany Zhang.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC809 (FAS) - (06/04)
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