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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002632
Report Date: 06/24/2025
Date Signed: 06/24/2025 03:25:37 PM

Document Has Been Signed on 06/24/2025 03:25 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:HUANG, YANFACILITY NUMBER:
414002632
ADMINISTRATOR/
DIRECTOR:		HUANG, YANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 288-2715
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
06/24/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Yan HuangTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On June 24, 2025 at approximately 1:15pm, Licensing Program Analyst (LPA) Catrina Quimb conducted an announced, annual inspection. LPA met with licensee, Yan Huang, and explained the purpose of the visit. Present during visit included licensee, licensee's mom, licensee's assistant and 12 children (4 infants and 8 preschool age). Licensee is a large license and is operating within capacity limits and ratio during LPA's visit.

Licensee lives in the multi-level home with their spouse, mother, adult child, and 2 minor children. All adults living in the home and staff present, having fingerprint clearance on file.

Hours of operation are Monday through Friday 8:30am to 6:00pm. The home includes two levels. Family child care program operates on the second level of the home (main level) only. The DAY CARE AREAS are living room, bedroom #1 (napping only), bedroom #2 (napping only), bedroom #3 (not currently in use), bathroom (next to kitchen), playroom (connected to napping bedroom), and front portion of backyard. The OFF LIMIT AREAS are kitchen (pass by only), hallway bathroom (next to bedrooms), upper portion of backyard, patio area (pass by only), and entire ground level of home. Off limit areas are made inaccessible with a child safety gate.

With licensee, LPA inspected day care areas for health and safety hazards. LPA observed home to have a variety of toys and equipment that are age appropriate. Toys and materials, when not in use, are appropriately stored and organized. There is a fireplace in the living room that is made inaccessible to children. LPA observed electrical outlets to also be made inaccessible to children with child safety covers. There are cabinets and drawers in day care areas that were observed to have child safety locks installed. LPA observed poisons and cleaning solutions to be stored behind child safety locked cabinets.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2025
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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Document Has Been Signed on 06/24/2025 03:25 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 06/24/2025 at 02:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUANG, YAN
FACILITY NUMBER: 414002632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)(3)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed blankets hanging on the sides of a crib, while an infant was in the crib, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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LPA reminded licensee cribs cannot have anything hanging on the side of them. Licensee removed blankets hanging on the sides of the crib during LPA's visit. Licensee stated they will not hang blankets on the side of cribs. Deficiency cleared during visit.
Type B
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. LPA observed an infant in a sleeping sack, while in a crib, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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Licensee stated infant's parents brought sleeping sack and requested infant to sleep in sleeping sack. LPA reminded licensee sleeping sacks cannot be used in any licensed childcare facility. Licensee stated they will not use sleep sacks. Licensee removed sleep sack from infant during LPA's visit. Deficiency cleared.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2025


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: HUANG, YAN
FACILITY NUMBER: 414002632
VISIT DATE: 06/24/2025
NARRATIVE
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Food service is provided by licensee that includes a hot lunch, if needed. Per licensee, children bring their own food. LPA observed children's lunches to be stored appropriately, labeled with children's names.

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/.

Bathroom for children's use was observed to be in working condition and equipped with age appropriate toileting equipment. Children's families provide diapers and wipes that are appropriately stored. LPA observed children's diapers to be labeled with their individual names. There is a garbage bin with a tight fitting lid to dispose of dirty diapers.

Children sleep on cots and in cribs. Licensee provides sheets for cots while children's families bring personal blankets for cots. LPA observed sheets and blankets to be appropriately stored when not in use. Licensee maintains sleeping logs for napping infants. LPA observed sleeping logs to include the 15 minute time stamp of when the infant is checked on while napping and the name of the staff member checking on the infant. LPA reviewed sleeping logs from random months of the year from 2023, 2024 and 2025. During today's visit, LPA observed an infant to be in a crib with blankets hanging on the side of the crib. LPA also observed infant to be in a sleeping sack, while in the crib.

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.

Entire backyard is fully fenced and enclosed. Children utilize the front portion of the backyard only while patio area and upper portion of backyard are off limits. There are stairs in the backyard that are made inaccessible with child safety gates. Backyard include a variety of outdoor toys and materials in good condition. Per licensee, toys and materials are sanitized daily. LPA did not observe any pools, spas or bodies of water on site.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
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: HUANG, YAN
FACILITY NUMBER: 414002632
VISIT DATE: 06/24/2025
NARRATIVE
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Home is equipped with a fully charged fire extinguisher, multiple first aid kits and a smoke and carbon monoxide detector. LPA tested carbon monoxide detector during today's visit, which was observed to be working.

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 and are appropriately documented. Last earthquake drill was conducted 12/04/2024. LPA reminded licensee disaster drills must be documented at least once every six months. Per licensee, there are no weapons or firearms in the home.

LPA reviewed facility records that included all enrolled children's records, licensee's record and assistants' records. Children's records are complete. Licensee has a current CPR certification that will expire 11/2025. Licensee and assistants present have a current Mandated Reporter certifications and required immunizations available for review.

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, Yan Huang, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today's visit, a Type B citation was issued due to an infant wearing a sleep sack while in a crib. A second Type B citation was issued due to blankets hanging on the side of a crib while an infant was in the crib. Licensee removed the sleep sack and blankets during LPA's visit. Deficiencies were also cleared as of today. Appeal rights were provided to licensee.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Yan Huang.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC809 (FAS) - (06/04)
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