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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004693
Report Date: 01/03/2024
Date Signed: 01/03/2024 10:47:29 AM

Document Has Been Signed on 01/03/2024 10:47 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KUO, WAN YUFACILITY NUMBER:
414004693
ADMINISTRATOR:KUO, WAN YUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 380-8555
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
01/03/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Wan Yu KuoTIME COMPLETED:
11:00 AM
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On 1/3/2024, at approximately 8:45AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Kuo Wan Yu. LPA explained the purpose of the visit. Present during the visit was the Licensee, two helpers, three infants and six preschool age children. All adults working or living in the home have acquired fingerprint clearance and are associated to the facility. The facility is in compliance with capacity requirements on this day. The facility’s operating hours are from 8:00AM to 6:00PM.

The facility is a two story, three-bedroom, two-bathroom home.

Daycare Areas: Sunroom (used as primary daycare space), Bedroom #2, Extra Room (adjacent to Sunroom and Kitchen), and Backyard.
Off-limits Areas: Master Bedroom, Bedroom #1, Bathroom #1, Bathroom #2, Living Room, Dining Room, Kitchen, Pantry, and Garage.

LPA inspected the home for any health and safety hazards. LPA observed the facility to be equipped with age-appropriate toys and learning materials. Poisons, cleaning detergents and other chemicals are stored inaccessible to children. Electrical outlets were observed to be covered or obstructed by furniture to not be accessible to children. The facility is equipped with a fully charged 3A40BC fire extinguisher. There is a combination smoke and carbon monoxide detector that was demonstrated to be operational. The first aid kit is fully equipped with materials necessary to administer first aid. There are mats available for preschool age children to sleep on. Parents bring bedding from home and take them home once a week to wash. There are four cribs present in the Sunroom, and LPA observed all cribs to be free of loose debris and other articles. There is proper heat and ventilation in the home. There is no fireplace in the daycare areas. Per Licensee, there are no firearms or weapons in the home.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2024
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 3
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: KUO, WAN YU
FACILITY NUMBER: 414004693
VISIT DATE: 01/03/2024
NARRATIVE
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The Backyard was observed to be equipped with age-appropriate toys and equipment for children in care. The Backyard is enclosed by a fence that is at least five feet high.

LPA reviewed three personnel files and nine children’s files. All personnel files were found to be complete. Licensee’s First Aid/CPR training expires 8/15/2024. Licensee’s Mandated Reporter Training expires 7/11/2025. All children’s files were observed to be complete, and all infants had sleep logs available for review.

All required postings were observed to be posted in a visible area of the Sunroom. Emergency drills are conducted and logged properly. The last emergency drill was conducted on 12/5/2023. The facility provides lunch and AM/PM snack for children in care.

During the visit, Licensee requested that Bathroom #1 be changed to an off-limits area. Per Licensee, children use the portable floor potty seat. Bathroom #1 has not been used for children in care. LPA approved the change in daycare areas, pending submission of an updated LIC999 (Facility Sketch) from 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 [email protected]. 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.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: KUO, WAN YU
FACILITY NUMBER: 414004693
VISIT DATE: 01/03/2024
NARRATIVE
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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.

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.

No deficiencies were cited during today's visit.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Wan Yu Kuo.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
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