414004502-3-14-2024-05-CC-JGIL-D3CR2A-20240314123802

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004502
Report Date: 03/14/2024
Date Signed: 03/14/2024 12:38:11 PM

Document Has Been Signed on 03/14/2024 12:38 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:	XIAO, YANG		FACILITY NUMBER:	414004502
ADMINISTRATOR:	XIAO, YANG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 544-8111
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 8	DATE:	03/14/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:03 AM
MET WITH:	Yang Xiao		TIME COMPLETED:	01:00 PM

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On March 14th, 2024, at approximately 10:00 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with licensee, Yang Xiao (Coco), and explained the purpose of the inspection. Present during LPA's visit included 8 enrolled children (8 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. Present in the home was licensee, and two assistants. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:00 AM to 6:00 PM. Licensee live in a single-level home with husband.
Day Care Areas: the living room, dining area, bathroom, bedroom #1, bedroom #2, covered patio, backyard, both cabins in backyard and garage (converted to bedroom).
Off Limit Areas: the master bedroom, and kitchen. Off limit area is made inaccessible to children with closed and locked door/gates.

LPA toured day care areas of home with licensee. LPA observed the home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in working condition. LPA observed a fully stocked accessible first aid kit. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPA observed electrical outlets to be made inaccessible with furniture. Home is equipped with one fully charged fire extinguisher and multiple dual smoke/carbon monoxide detectors. LPA tested carbon monoxide detector in living room area, which was observed to be working. All cabinets in accessible areas to children do not contain any hazardous items or have safety locks. Per licensee she has no children in care with allergies, or medications. Per licensee, parents provide lunch for children in care.

Bathroom for children's use was observed to be in proper working condition. LPA observed bathroom to include appropriate toileting equipment and sanitation products. LPA did not observe any hazardous materials to be accessible to children in the bathroom.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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: XIAO, YANG	FACILITY NUMBER: 414004502
	VISIT DATE: 03/14/2024

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LPA observed licensee to utilize a play pens for nap time for her children in care. Per licensee, all parents wash sheets once a week. The entire backyard is fully enclosed. The outdoor area is equipped with a variety of toys and materials. LPA observed multiple storages that are closed and inaccessible to children while outdoor. LPA did not observe pools, spas, or bodies of water.

LPA reviewed five child’s records which were not complete. The child’s file has a record of emergency identification information, required immunization but was missing parent rights. Per licensee, she confused the form with personal rights form and has sent parents correct form to sign via email. Once form is signed, she will email them to LPA Gil. LPA reviewed staff records for licensee which were not complete. Licensee has CPR/FIrst Aid that is current and will expire 5/2025. Licensee has Mandated Reporter training certification that is also current and will expire 3/2026. Assistants do not have Mandated Reporter Training's complete. Per licensee, they will begin that, and send certificate copies to the department. Licensee has required immunization available for review. One assistant is missing immunization records. All staff is missing TB results. LPA reminded licensees that all immunization records must be placed in staff files available to the department for review.

Licensee has licensing documentation properly posted and available for review. The licensee also maintains a childcare roster that was made available for review. Emergency disaster drills are conducted at least once every six months. The last disaster drill was conducted on January 5, 2024. Per licensee, there are no weapons or firearms in the home.

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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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: XIAO, YANG	FACILITY NUMBER: 414004502
	VISIT DATE: 03/14/2024

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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 childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Yang Xiao (Coco), confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

Exit interview conducted and report was reviewed with the licensee, Yang Xiao(Coco).

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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