414004541-2-10-2023-05-CC-CQUO-CNWT6A-20230210132648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004541
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:27:03 PM

Document Has Been Signed on 02/10/2023 01:27 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	WU, LEILEI		FACILITY NUMBER:	414004541
ADMINISTRATOR:	WU, LEILEI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 417-5342
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 12	DATE:	02/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lei Lei Wu		TIME COMPLETED:	01:45 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 February 10, 2023 at approximately 11:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Lei Lei Wu, and explained the purpose of the inspection. Present during LPA's visit included licensee, licensee's assistant (T1) and 12 enrolled children (3 infants and 9 preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. Hours of operation are Monday to Friday 8:00am to 6:00pm. Licensee lives in the home which is a single level, single family home. The DAY CARE AREAS are the living room and dining area (main classroom), bedroom #1 (nap room), bathroom #1, and part of the backyard (deck area). The OFF LIMIT AREAS are the kitchen, garage, bedroom #2, master bedroom and portion of backyard. Off limit areas are made inaccessible with child safety gates and/or locked doors. With licensee, LPA toured day care areas of home. At approximately 12:00pm, LPA observed children present to be going down for naptime. LPA observed T1 to be supervising at least 7 children in the nap room. Program operates as a Montessori bilingual day care. LPA observed the home to be in good repair with proper temperature and ventilation. LPA observed electrical outlets in home to be properly barricaded with child safety covers and/or barricaded by furniture. Living room includes a fire place that is made inaccessible and properly barricaded with furniture. Home is equipped with a variety of age appropriate toys, Montessori materials and equipment that were in good working condition. LPA observed cleaning supplies, poisons and other chemicals to be stored inaccessible in home's high shelves and/or locked behind child safety locked cabinets. There is sufficient storage for children's belongings inside the home. Bathroom was observed to be in proper working condition with appropriate sanitation products. (Continue Report on Page 2...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, LEILEI	FACILITY NUMBER: 414004541
	VISIT DATE: 02/10/2023

NARRATIVE

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Home is equipped with a working smoke and carbon monoxide detector, fully charged fire extinguisher, and a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home.

The entire backyard is enclosed with an at least 5 ft. high fence. Due to recent storm that occurred, portion of fence in backyard was observed to be under construction. Per licensee, neighbor and licensee are currently working to fix fence together.

Backyard is equipped with sufficient toys and equipment that were age appropriate. LPA did not observe any spas, pools, or bodies of water on site.

LPA reviewed five children's records which were complete. Children's files have a record of emergency identification information on file. Licensee has a valid and current CPR certification that will expire 02/2024. Licensee also has a current Mandated Reporter certification that will expire 04/2024. Licensee's required immunizations were made available for review.

Last emergency disaster drill was conducted 02/03/2023 . Emergency drills are conducted at least once every six months and are properly logged. Licensing documents are properly posted and made available for review inside the home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm.

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 tools, please send them by email 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/process
(Continue Report on Page 3...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, LEILEI	FACILITY NUMBER: 414004541
	VISIT DATE: 02/10/2023

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

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-and-resources/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.

During inspection, LPA observed T1 to be supervising children. T1 was not observed to have fingerprint clearance or association to facility. Civil penalty was assessed. Please refer to 809D for more information.

LPA Quimbo informed licensee, Lei Lei Wu, that this report dated 02/10/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Quimbo informed the licensee to provide a copy of this licensing report dated 02/10/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with licensee, Lei Lei Wu.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/10/2023 01:27 PM - It Cannot Be Edited

Created By: Catrina Quimbo On 02/10/2023 at 01:01 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: WU, LEILEI	FACILITY NUMBER: 414004541
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or 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 which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/13/2023
	Plan of Correction
1 2 3 4	LPA reminded licensee all adults working or living in the home must have fingerprint clearance prior to initial presence in licensed family child care home. Licensee stated T1 will go through fingerprinting process by the end of 02/10/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Catrina Quimbo

LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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