384005193-4-9-2026-05-CC-MTSO-DSYNT8-20260409104420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384005193
Report Date: 04/09/2026
Date Signed: 04/09/2026 10:44:37 AM

Document Has Been Signed on 04/09/2026 10:44 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:	LI, SHUNA		FACILITY NUMBER:	384005193
ADMINISTRATOR/ DIRECTOR:	SHUNA LI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 988-5799
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94158
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/09/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Shuna Li		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

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 April 9, 2026, at approximately 8.30am, Licensing Program Analysts (LPAs) Tso and Naves met with the Licensee, Shuna Li, for an announced pre-licensing inspection. The licensee has applied for relocation of a Large Family Child Care License. The Licensee was present at home. The applicant rents this unit with 2 bedrooms (one on level 1 and the other one on level 2), 2 bathrooms (one on level 1 and the other one on level 2), living room and kitchen. The home resident is the Licensee. The childcare area will be provided in the living room, bedroom # 1, bathroom # 1 on level 1 and bedroom # 2 on level 2 (for napping only). The off-limit areas are the bathroom # 2, the stairway from level 1 to level 2, the hallway on level 2 (the stairway from level 1 to level 2 and the hallway on level 2 are the pathway to bedroom # 2), and the kitchen on level 1. LPAs reminded the Licensee that no infants to be cared for and napping in the bedroom # 2 on the level 2. The Licensee stated that she would arrange a helper to supervise the children in care in bedroom # 2 that would not leave the children unattended at any time, especially in bedroom # 2. The days and hours of operation will be Monday - Friday, 8:00 am to 6:00 pm, and care for children between 3 months old to 12 years old. Per the licensee, the licensee plans to utilize the bedroom # 1 on level 1 as an isolation for sick/ill children. LPAs and the Licensee inspected the entire home for Health and Safety Hazards. The house is clean and orderly and has sufficient lighting and ventilation. LPA observed a crib and a mattress in the bedroom #1. LPAs reminded the licensee to keep cribs free of toys, pillows, and hanging objects. Mattresses must be designed for cribs, and bed sheets should fit tightly. There are a variety of age-appropriate toys for children. All furniture and playthings were observed to be in good repair. (Continued on page 2...)

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Man Tso
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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: LI, SHUNA	FACILITY NUMBER: 384005193
	VISIT DATE: 04/09/2026

NARRATIVE

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The home has a smoke and carbon monoxide detector. During the inspection, the detector was tested and worked. All harmful objects, sharp objects, and toxins are stored out of the reach of children and made inaccessible to children. The Licensee states that no weapons, firearms, or pets are in the home. LPA observed no body of water, such as a swimming pool, spa, hot tub, or fishpond. All unused electrical wires/power surges were observed covered.

LPAs informed the Licensee that emergency drills are required every six months, and the Licensee must document the drills. The Licensee was 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 Licensee was also reminded that smoking is prohibited at the daycare.

The Licensee plans to provide the children breakfast, morning snacks, lunch, and afternoon snacks. Per the Applicant, she intends to purchase liability insurance for childcare. LPAs informed the Licensee that if childcare insurance is not purchased, each parent must be given the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Licensee's Pediatric FirstAid and CPR, and Mandated Reporter Training are valid, and copies have been submitted to the Department.

LPAs reviewed with the Licensee 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 Licensee. The Licensee plans to have all required posting on the left wall of the main entrance. License capacity and limitation were also reviewed with the Licensee. LPAs informed the Licensee that if care is provided to the 13^th and 14^th child, who must be school-aged, parent notification and landlord consent are required.

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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Man Tso
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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: LI, SHUNA	FACILITY NUMBER: 384005193
	VISIT DATE: 04/09/2026

NARRATIVE

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LPA discussed the safe sleep regulations with the Licensee 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 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.

The Licensee 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 Licensee has obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the Licensee 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 Licensee 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.

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 Licensee 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 Licensee was encouraged to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. The Licensee 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.
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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Man Tso
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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: LI, SHUNA	FACILITY NUMBER: 384005193
	VISIT DATE: 04/09/2026

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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 Licensee 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.

The Central County Fire Department issued a fire clearance for the home on 03/19/2026, as necessary for a Large Family Child Care Home.

The Applicant's home meets the licensing requirements of a Large Family Child Care Home (FCCH) today, and licensure is recommended and approved on 4/13/2026.

The report was reviewed and signed by the Licensee, Shuna Li. Today's report was provided to the Licensee. 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.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Man Tso
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC809 (FAS) - (06/04)

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