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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004595
Report Date: 08/21/2023
Date Signed: 08/21/2023 03:25:38 PM

Document Has Been Signed on 08/21/2023 03:25 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:WANG,YANFACILITY NUMBER:
384004595
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Yan WangTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Yee conducted an Unannounced Required - 1 Year inspection today. The purpose of the visit was explained. LPA met with the licensee, Yan Wang, and 3 daycare children (3 infants). The facility personnel summary report was reviewed with Yan and she said it is current. Current residents are the licensee, Yan Wang and her 6 yr old daughter. The new lease agreement is on file.

Daycare areas are: living room, kitchen, hallway bathroom, and bedroom #1. The licensee had requested to change her daycare areas from upper level to the lower level. The lower level was inspected today. Daycare areas (lower level): play room #1, play room #2, nap room, kitchen, bathroom and backyard. The remaining of the house are off limits. CPR and 1st aid certificate was not available during the inspection. The licensee said she renewed in May and will locate it and submit a copy to CCL by next week.

LPA observed the home is clean orderly and properly ventilated. Fire extinguisher is size 2A10BC. Smoke detectors and carbon monoxide is available. There are no bodies of water in the home. Electrical outlets have child protective covers in place making them inaccessible to children. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. Kitchen/Bathroom cabinets/drawers have child protective locks in place making all sharp objects or toxic house hold items inaccessible to children. First aid supplies are available for children. Disciplinary policy was discussed with Licensee today. Home has age appropriate toys and equipment available for the children in care. Children bring their own food.

The children files were reviewed.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2023
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: WANG,YAN
FACILITY NUMBER: 384004595
VISIT DATE: 08/21/2023
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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, before 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.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was reminded about Mandated Reporter Training available on the CCLD website www.ccld.ca.gov
or www.mandatedreporterca.com). AB1207 was completed on 10-2021.

LPA discussed the safe sleep regulations with the 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. LPA reminded the licensee that she needs to be on the same floor at all times. Also suggested to hire a helper for extra help.

>This report must be available in the facility for public review. Notice of site visit was given and must remain posted for 30 days.

Licensee was advised any additional questions to call Office, M-F, 8 am-5 pm, 650-266-8800 or
1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC809 (FAS) - (06/04)
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