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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002549
Report Date: 08/12/2024
Date Signed: 08/12/2024 04:20:27 PM

Document Has Been Signed on 08/12/2024 04:20 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:XU, JUNFACILITY NUMBER:
414002549
ADMINISTRATOR/
DIRECTOR:		XU, JUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 249-0298
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/12/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee, Jun XuTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On August 12, 2024 at 2pm, Licensing Program Manager (LPM) Marie Rodriguez, and Licensing Program Analysts (LPAs) Leslit Tapia-Mandujano, Winnie Ly, and Almond Tso met with licensee, Jun Xu for an informal office meeting. Present during meeting included Licensed provider, Zhifang “Catherine” Ma (414004958).

The purpose of the informal meeting was to address licensee's non-compliance with facility. On 7/12/24, LPA Almond Tso conducted an annual inspection and cited six type B citations. Citations discussed were:
· Operation of a Family Child Care Home: 102417(g)(9)(A)(1): Fire Drills
· Personnel Requirements: 102416.1(d): Personnel Records
· Child’s Record: 102421(a): Children’s Records
· Operation of a Family Child Care Home: 102417(g)(8): Children’s Roster
· Infant Safe Sleep: 102425(j)(2): Sleep Logs
· Personnel Requirements: 102416(c): Health and Safety Trainings (CPR & First Aid)

Licensee was advised and reminded of the following:
· Licensee must be present in the home 80% of operating hours, a day.
· Licensee is responsible and liable for anything that occurs in the home even if an employee is present. Licensed provider, Zhifang “Catherine” Ma (414004958) is not “in charge” of the facility.
· If licensee is temporarily to leave home, any employee working in the home, assistants and helpers, must have a current CPR/ First Aid certification when left alone with the children.
· Licensee must maintain all required documentation for all children and employees who are present in the home.
· Licensee must comply with all safe sleep regulations.

Licensee stated they are aware of the importance to be in compliance with all licensing regulations. Department will conduct additional visits to licensee's home to verify licensee's compliance with regulations.

During meeting, licensee was provided Safe Sleep Regulations, Operation of a Family Child Care Home Regulations, Inspection Authority of the department, and forms and records to maintain for employees and children in the home (LIC 311D).

Exit interview conducted and report was reviewed and translated into Mandarin by LPA Tso to licensee, Jun Xu.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2024
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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