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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005048
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:33:21 AM

Document Has Been Signed on 09/14/2023 10:33 AM - 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:TSAGANN, SARANTUYAFACILITY NUMBER:
414005048
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/14/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sarantuya TsagannTIME COMPLETED:
10:45 AM
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Licensing Program Analysts (LPAs) Andrea Medlin and Jonathan Tse met with applicant for this prelicensing visit. Days and hours of operation: Monday-Friday 7:30AM-5:30PM. Applicant rents the home; control of property documents were reviewed and verified and on file. Applicant and adult son are the only ones living in the home; criminal record clearance is on file for all adults in home. Applicant reminded once a person turns 18 years of age and if living or working in the daycare, criminal record clearance is required. The daycare will operate in the following areas: living room, bedroom on lower level for napping; bathroom, and gated off area of backyard. The rest of the home is off limits. There is a fully charged fire extinguisher that meets minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the home. First Aid and emergency supplies are available. Applicant will separate a sick child from the group waiting for parent to pick up. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per applicant, there are no pets or firearms or weapons in the home. Applicant has current Pediatric First Aid and CPR (exp 5/9/2025) and 8 hours of Health and Safety training is on file. There are sufficient age appropriate toys and children's equipment in the day care. Bathroom is clean and hazardous material is child proofed and inaccessible to children. Applicant has verification of the required staff immunizations: measels (MMR) and pertussis (TDap). Applicant has verification of the required mandated child care reporter training as compliant with AB1207 (exp 9/4/2025). Applicant will purchase liability insurance for the child care. If child care is provided to the 7th and 8th child, children must be school age (6 years or older), Parent Notification, and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and new License (once received). A packet of records to be maintained is provided and discussed with applicant and requirements regarding Unusual Incident Report discussed.

(Continued on next page 809-C)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: TSAGANN, SARANTUYA
FACILITY NUMBER: 414005048
VISIT DATE: 09/14/2023
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This home meets the requirements of Family Child Care Home (FCCH) and licensure is recommended and approved as of today, 9/14/2023.

This report is reviewed with applicant and a copy of this report must be made available for pubic review upon request.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
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