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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005048
Report Date: 12/19/2024
Date Signed: 12/19/2024 01:06:21 PM

Document Has Been Signed on 12/19/2024 01:06 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:TSAGANN, SARANTUYAFACILITY NUMBER:
414005048
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Sarantuya TsagaanTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 12/19/2024, at approximately 10:30AM, Licensing Program Analysts (LPAs) Alvarado and Tse conducted an unannounced annual visit at the facility. LPA Alvarado met with Licensee Sarantuya Tsagaan and disclosed the purpose of the visit for today. Licensee had applied for an increase of capacity. Present in the Facility is Licensee supervising 1 infant. Everyone in the household has fingerprint clearance and are associated to the facility. Fire clearance was granted on 10/30/2024.

Daycare area: Living Room, Dining Room, Room #1, bathroom (only for children use) on the second level, and the Backyard.
OFF limit area: Kitchen, Room #2, Room #3, and Garage

LPA inspected the home for any health or safety hazards with Licensee Sarantuya Tsagaan. LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged fire extinguisher. Facility has a combination smoke and carbon monoxide detector. There is a fireplace present in the facility that is properly barricaded and made inaccessible to children. Per Licensee, there are no firearms present in the facility. Phone number listed for Licensee is current. Licensee’s CPR/First Aid are all updated and current expiring 5/2025. Licensee’s Mandated Reporter Training expires 9/2025.

Facility hours of operation are Monday-Friday 7:30AM-5:00PM. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Parents provide children’s Breakfast, Lunch and Snack. Licensee will also provide water and small snacks if need to. Licensee provides sheets and blankets and washes them once a week.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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: TSAGANN, SARANTUYA
FACILITY NUMBER: 414005048
VISIT DATE: 12/19/2024
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LPAs and Licensee inspected the home for any health or safety hazards. LPAs observed one infant in the crib with a blanket and pillow, Licensee was reminded that cribs need to be free of loose materials. Licensee removed the blanket and pillow. Safe sleep was discussed with the licensee. LPAs observed an exersaucer and two bassinets. Licensee removed the exersaucer and placed it in an off-limit are of the home. Licensee will be removing the two bassinets. There are no pools or other bodies of water present in the facility. Licensee was reminded that baby walkers, bouncers, jumpers, and any other similar items are to not be used for children in care.

LPA reviewed Licensee’s record, two children’s files, and facility records. Children’s files were observed to be complete. Infant sleeping logs were available for review. Required postings were discussed with Licensee.

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.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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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: TSAGANN, SARANTUYA
FACILITY NUMBER: 414005048
VISIT DATE: 12/19/2024
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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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The deficiencies cited on the following pages are in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1.

See LIC809-D for deficiency cited regarding Infant safe sleep. See LIC9102-TV for technical violation and Technical Advisory issued today regarding Physical Plant. Appeal rights were provided and explained to Licensee Sarantuya Tsagaan. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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: TSAGANN, SARANTUYA
FACILITY NUMBER: 414005048
VISIT DATE: 12/19/2024
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During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee, Sarantuya Tsagaan.

Prior to approval of a large license, Licensee shall:
1) Remove the bassinets, baby bouncer, and exersaucer from the home.
2) Completely gate the outdoor play area that is intended for use by children.
3) Repair the gate in the side exit of the home.
4) Remove the sandbox located in the Backyard from the home.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/19/2024 01:06 PM - It Cannot Be Edited


Created By: Diana Alvarado On 12/19/2024 at 12:18 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: TSAGANN, SARANTUYA
FACILITY NUMBER: 414005048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in one out of two objects which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/03/2025
Plan of Correction
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Licesnee will remove the baby bouncer and exersaucer from the facility. Licensee will submit photos to LPA Alvarado by 1/3/25 indicating those items are not presnet in the facility.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in one out of one persons which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/03/2025
Plan of Correction
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Licesnee will remove all blankets, pillows, and toys from the cribs. Licensee wil submitt photos to LPA Alvarado by 1/3/25.
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:Ali Zebila
LICENSING EVALUATOR NAME:Diana Alvarado
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2024


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