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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004481
Report Date: 06/27/2023
Date Signed: 06/27/2023 02:17:10 PM

Document Has Been Signed on 06/27/2023 02:17 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:YAN, JESSICA P.FACILITY NUMBER:
414004481
ADMINISTRATOR:YAN, JESSICA P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 218-9806
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Jessica YanTIME COMPLETED:
02:25 PM
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On 6/27/2023 at 12:10PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Jessica Yan. Purpose of the inspection was explained and was for an Unannounced; Annual Random inspection. Present in facility was the licensee and licensee’s mother/ assistant caring for 10 children (7 preschool age, 2 infant age, 1 school age). Per licensee, school age child present is her son. Adults have criminal record clearances on file. Licensee’s home is a three bedroom, three bathroom, two level house. Days and hours of operations are: Monday- Friday, 7:30AM., to 5:30PM. Daycare areas are: 1st Floor: Living Room (Playroom), Bathroom #1, Living Room #2 (Infant Area), Family/ Dining Room (Lunch Area) and Backyard. Off Limit areas are: 1st Floor: Kitchen, Garage, Laundry Room and Entire 2nd Floor: Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #2, Office, and Bathroom #3. LPA inspected facility, indoor and outdoors, with licensee for health and safety hazards.

At 12:15PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were clear of obstructions or possible hazards. Accessible furniture, blocks and books inspected were in good repair. Child sized table and chairs are available for snack and seated activities. For napping services, LPA observed cots and play pen stored in Playroom #1. Playpen was stored for each infant in care. Per licensee, napping sheets are washed weekly. The off-limit areas, including garage and upper level, have been made inaccessible. Bathroom #1 was maintained clean, with and adequate supplies for hand washing. Fixture were in operating condition. Facility was the proper temperature, with ventilation, and lighting. Home had functioning telephone service, smoke/ carbon monoxide combination detector and fire extinguisher, fully charged; size 2A10:BC, under staircase.

At 12:35PM., LPA inspected facility backyard area. Area is completely enclosed with tall fencing. Playthings inspected were in good repair. Licensee has several sensory/ activity tables for children in care. Home does not have any pools, fishponds, jacuzzi, or bodies of water. (REFER TO 809C, FOR CONT)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YAN, JESSICA P.
FACILITY NUMBER: 414004481
VISIT DATE: 06/27/2023
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(Page 2)
At 12:50PM, LPA reviewed facility and children’s records. Children’s files were reviewed and included the: Notification of Parent's Rights (LIC995); Affidavit regarding Liability Insurance (LIC282); Identification of Emergency Information (LIC702); Immunization Records; and Consent for Medical Treatment (LIC627).

LPA confirmed licensee is documenting infant napping conditions every 15 minutes.

Licensees Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 04/2025.


Licensees Mandated Reporter Training’ (AB1207) certification was current, expiring: 3/2025.

Facility is conducting emergency disaster drills every six months, with last one done on 5/5/2023 properly logged.

Required posting are posted in facility, including the Childcare License; Notification of Parent’s Rights (PUB379), Emergency Disaster Plan (LIC610A); Per licensee, isolation of an ill children is in the playroom.

LPA advised licensee to ensure all children’s meal containers brought by families must be labeled. Per licensee, home does not have any firearms.

Licensee was reminded all adults, 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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 up to $500.00 maximum per day/ per person will be assessed if this regulation is violated.


(REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YAN, JESSICA P.
FACILITY NUMBER: 414004481
VISIT DATE: 06/27/2023
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(Page 3)
LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will 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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations. LPA conducted exit interview with Jessica Yan, and licensees’ signature of this form acknowledges receipt of these documents.

Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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