<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004981
Report Date: 05/30/2023
Date Signed: 05/30/2023 12:45:57 PM

Document Has Been Signed on 05/30/2023 12:45 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:CHEN, YONGLIFACILITY NUMBER:
414004981
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/30/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Applicant, Yongli ChenTIME COMPLETED:
01:30 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 May 30th, 2023 at approximately 8:30am, Licensing Program Analyst (LPA), Leslit Tapia-Mandujano conducted a scheduled Pre-Licensing inspection this day and met with Applicant, Yongli Chen. Applicant has applied for a Small Family Child Care License. Present in the home today is applicant and applicant's husband. LPA and applicant inspected entire home for Health and Safety Hazards.

Applicant owns a 3 bedroom three bathroom house with a Guest house in the back. Applicant lives in the home with husband. The hours of operation are Monday-Friday from 8am-6pm. Daycare areas are: Living Room, Dining Room, Bathroom #3, and portion of the backyard (directly behind the home). Applicant will occasionally take the children to the left side of the backyard and the front yard with the gates closed OFF limit areas are: All the Bedrooms (#1-#3), Bathroom #1 and #2, Office, Kitchen, Laundry Room, Garage, and Guest House. The Guest has its own entrance/exits and it is currently occupied. All off limit areas are properly barricaded, including closets.

LPA observed the following: Daycare Area is clean with sufficient light and ventilation. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and thermometer. The home has no pools or bodies of water in the home. Per applicant, there is only chickens in the home in the chicken coop. Home does have a fireplace that is properly barricaded. Per applicant, there are no guns or weapons in the home. The home has age appropriate equipment available for children in care. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. Discipline policy was discussed. Isolation area for sick child will be in the entryway.

Applicants states they will conduct an emergency drill once every six months and log drills. Applicant's CPR & First Aid will expire on 12/2024 and for Mandated Reporter Training Certificate will expire on 11/2023.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Continued on Page 2...
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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 2
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: CHEN, YONGLI
FACILITY NUMBER: 414004981
VISIT DATE: 05/30/2023
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
26
27
28
29
30
31
32
Page 2 Continued...

LPA discussed the safe sleep regulations with applicant 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
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: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Prior for approval of Small Family Child Care License, applicant must complete the following:
*Submit proof of that the Detergent in Laundry room is inaccessible to children in care
*Submit proof of backyard/front yard being completed in a way that it is safe for children in care
*Submit proof of all adults having fingerprint clearance
*Submit Proof of Important Documents posted in the Entryway
*Submit Proof of Bedroom #3 completely set up

Exit interview conducted and report was reviewed with the applicant, Yongli Chen.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2