414004123-9-10-2024-05-CC-DALO-D8Z2KU-20240910172832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004123
Report Date: 09/10/2024
Date Signed: 09/10/2024 05:29:00 PM

Document Has Been Signed on 09/10/2024 05:29 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:	ZHANG, MIAO HONG		FACILITY NUMBER:	414004123
ADMINISTRATOR/ DIRECTOR:	ZHANG, MIAO HONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 837-8328
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	09/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Miao Hong Zhang		TIME VISIT/ INSPECTION COMPLETED:	05:45 PM

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 9/10/2024 Licensing Program Analysts (LPAs) Alvarado and Tse arrived at the facility listed above. LPAs arrived at approximately around 2:05pm and met with Licensee, Miao Hong Zhang. LPA Alvarado disclose the purpose of the of the inspection which was an annual inspection and entered the facility to begin the inspection. Present in the facility are Licensee supervising 11 children (4 infant and 7 preschool age children), along with two helpers. The licensee is operating within capacity limits on this day. All adults living and working in the facility are fingerprint cleared and associated. The facility’s operating hours are from 7:30AM to 6:00PM, Monday to Friday. Daycare Areas: First Floor Only: which is the Living Room (Kids Room), Bedroom, Bathroom and the Backyard. Off Limit Areas: Entire second Floor: On the First Floor, Kitchen, Dining Room, Garage, In the Backyard: the outdoor Kitchen(Enclosed from all sides), and the Storage Shed. At 2:10 pm LPAs joined Licensee Miao Hong Zhang for an inspection of the facility. LPAs observed that the home is clean, orderly with a variety of age-appropriate toys for the children. All furniture inspected is in good repair. The home has no pools or similar bodies of water in the home. The home has a fireplace in the living room that is properly barricaded. The home has age-appropriate equipment available for children in care. Licensee was reminded that baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. LPAs observed three infants napping in the Bedroom and saw that two of the three sleeping infants were in sleep sacks. LPAs spoke to the Licensee and advised the Licensee that sleep sacks are not allowed. Licensee was also advised to maintain the door open at all times when infants are napping. Safe sleep regulations were discussed.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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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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: ZHANG, MIAO HONG	FACILITY NUMBER: 414004123
	VISIT DATE: 09/10/2024

NARRATIVE

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There was a fully charged fire extinguisher in the kitchen, in addition to a dual smoke alarm and carbon monoxide alarm throughout the home. Licensee uses their cell phone as the facility’s primary telephone. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. LPAs reviewed 10 children’s records which were complete. Licensees has a completed Mandated reporter training that is approved by the Department which expires 5/2026. Licensee’s Pediatric CPR/First Aid certification expires 1/2025.

All required postings, such as the facility license and Notification of Parents’ Rights have been placed in a prominent area for parents or authorized representatives to review. According to Licensee, emergency drills are conducted at least once every month. The last emergency drill was conducted on 6/5/2024.

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.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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: ZHANG, MIAO HONG	FACILITY NUMBER: 414004123
	VISIT DATE: 09/10/2024

NARRATIVE

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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 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.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC 809-D for deficiencies cited today regarding infant safe sleep (sleep logs and sleep sacks).

Appeal rights were given and explained to the 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, Miao Hong Zhang.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/10/2024 05:29 PM - It Cannot Be Edited

Created By: Diana Alvarado On 09/10/2024 at 04:58 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: ZHANG, MIAO HONG	FACILITY NUMBER: 414004123
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in two out of four infants which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	The licensee stated that they will remove all sleep sacks from use in care.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in four out of four infants which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee stated that they will submit sleep logs to LPA Alvarado by 9/30/24.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Ali Zebila

LICENSING EVALUATOR NAME:

Diana Alvarado

LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC809 (FAS) - (06/04)

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