414005344-7-16-2026-05-CC-CQUO-DW2T4T-20260716142427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005344
Report Date: 07/16/2026
Date Signed: 07/16/2026 02:24:46 PM

Document Has Been Signed on 07/16/2026 02:24 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:	SHU ACADEMY WEST CAMPUS		FACILITY NUMBER:	414005344
ADMINISTRATOR/ DIRECTOR:	TING SHEN		FACILITY TYPE:	860
ADDRESS:	3399 CSM DRIVE		TELEPHONE:	(510) 936-0199
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/16/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Ting "Katie" Shen		TIME VISIT/ INSPECTION COMPLETED:	03:15 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 July 16, 2026 at approximately 9:00am, Licensing Program Analyst (LPA) Quimbo conducted a scheduled, pre-licensing visit. LPA met with applicant, Ting "Katie" Shen, and explained the purpose of the visit. No children were present during today's visit. This is an initial application. Applicant submitted application February 10, 2026. Applicant originally requested an application for a total capacity of 60 children: 9 toddlers (18 months to 36 months) and 51 preschoolers (2 years to entry into first grade). Fire clearance for 60 children: 9 toddlers and 51 preschoolers was received July 13, 2026. Applicant updated the request for a total capacity of 60 children: 12 toddlers (18 months to 36 months) and 48 preschoolers (2 years to entry into first grade). Updated Application for a Child Care Center License (LIC200A) was received. Updated fire clearance with updated capacity of each component to be obtained. The facility will operate Monday through Friday 8:30am to 5:30pm. The director for facility will be the applicant. Program will operate at Western Hills Church on the ground floor of the facility only. There are 5 classrooms, 5 restrooms (for children's use), a preschool outdoor area and a toddler outdoor area. The preschool and toddler outdoor areas are physically separate from one another. LPA inspected day care areas for health and safety hazards and measured areas to ensure square footage is sufficient for capacity being requested. Toddler Indoor measurements are: There is one classroom for the toddler component. The indoor area contains a total of 426.29 square feet which will accommodate the request for 12 toddler children. (Continue report on page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: SHU ACADEMY WEST CAMPUS	FACILITY NUMBER: 414005344
	VISIT DATE: 07/16/2026

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Toddler Outdoor measurements are:
There is one toddler outdoor area. The outdoor area contains a total of 686.88 square feet which will not accommodate the request for 12 toddler children. An outdoor rotation waiver will be needed and was provided to LPA during today's visit.

Preschool Indoor measurements are:
There are four classrooms for the preschool component. The indoor area contains a total of 1,696.92 square feet which will accommodate the request for 48 preschool children. The preschool component will operate in "Pre-K1", "Pre-K2", "Big Preschool 1", and "Big Preschool 2".

Preschool Outdoor measurements are:
There is one outdoor area for the preschool component. The outdoor area contains a total of 3,901.43 square feet which will accommodate the request for 48 preschool children.

Sinks and Toilets:
There are a total of 7 sinks and 5 toilets for toddler and preschool children's use, which will accommodate the request for 60 children. Pre-K1, Big Preschool 1, Big Preschool 2, and Toddler classrooms have a restroom located inside the classrooms. Pre-K2 will utilize restroom in the hallway. There is a separate adult restroom also located in the hallway of facility.

The child care center was observed to be clean, sanitary and in good repair. Per applicant, toys and materials are sanitized daily. LPA observed toddler classroom to include soft toys and materials for children's use. A comfortable temperature for children is being maintained. Furniture and equipment were observed to be maintained in good condition. LPA observed tables to have soft padding on corners. Electrical outlets were also observed to have child safety covers installed. There are rugs in the classrooms that are clean, free of stains. Per applicant, rugs will be vacuumed daily. Per applicant, cleaning services will also be on site at least every two weeks. Storage cabinets in classrooms were observed to have child safety locks installed. LPA observed cleaning solutions, poisons and chemicals to be stored in classrooms' high shelves.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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: SHU ACADEMY WEST CAMPUS	FACILITY NUMBER: 414005344
	VISIT DATE: 07/16/2026

NARRATIVE

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Restroom for children's use was observed to be in working condition. There is a separate restroom in the Toddler classroom. Applicant plans to utilize a diaper changing pad for diapering, toddler children that is within arm's reach to a sink. Diapers and wipes will be provided by children's families and will be stored in individual bins, labeled with children's individual names. LPA observed classrooms to be equipped with garbage bins with tight fitting lids. Sinks for children's use do not provide hot water. There is sufficient storage space for children's personal belongings

Children will sleep on cots in their individual classrooms. Sheets and blankets will be provided by children's families. Per applicant, sheets and blankets will be stored in individual bags so that sheets are not touching each other. Per applicant, cots will be sanitized daily. Sheets and blankets will be sent home weekly for laundering.

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-andresources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for and removing 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.

Facility is equipped with a first aid kit, a fully charged fire extinguisher, fire alarm, smoke detectors and carbon monoxide detectors. LPA tested carbon monoxide detectors during today's visit, which was observed to be in working condition. When medications are on site, they will be stored in a locked cabinet, inaccessible to children.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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) or (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

Licensing documents will be posted in the hallway of facility. Children will be signed in and out of program through an electronic application. Per applicant, sign in and out sheets will be maintained for 30 days.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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: SHU ACADEMY WEST CAMPUS	FACILITY NUMBER: 414005344
	VISIT DATE: 07/16/2026

NARRATIVE

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Outdoor areas for toddler and preschool children are fully enclosed and fenced. There are stairs in the preschool outdoor area that lead to the off limit, second level of facility. LPA observed the bottom of the stairs to have a child safety gate installed.

Both toddler and preschool outdoor areas have equipment that are in good condition. There is a play structure in the preschool play yard that is labeled for children ages 2 years to 12 years old. LPA observed resilient padding underneath play structure. There is sufficient shade in both outdoor areas, when needed. LPA did not observe any pools, spas or bodies of water on site.

Program will provide a food service that will be through a third party vendor, delivered daily. Per applicant, children who participate in food service are to bring their own individual plates, containers and utensils that will be taken home daily to be washed. Children's families will also have the option to bring their own food.

Children will have access to drinking water through their own individual water bottles. LPA reminded applicant children's personal materials are to be labeled with their own individual names. Water bottles can be refilled on site through purchased, filtered water jugs.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA reviewed with applicant and director, the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant was informed of the MyChildCarePlan.org site, 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.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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: SHU ACADEMY WEST CAMPUS	FACILITY NUMBER: 414005344
	VISIT DATE: 07/16/2026

NARRATIVE

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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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. 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.

Facility will be approved for a total capacity of 60 children: 12 toddlers (18 months to 36 months) and 48 preschool children (2 years to entry into first grade) when following is complete:
-Posting of required licensing documents in hallway.
-Labeling of adult restroom in hallway.
-Updated fire clearance with updated capacity of components requested.
-Management approval of outdoor rotation waiver.
-Centralized Application Bureau (CAB) final approval of application.

Exit interview conducted and report was reviewed with the applicant, Ting "Katie" Shen.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC809 (FAS) - (06/04)

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