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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004609
Report Date: 01/17/2024
Date Signed: 01/17/2024 05:09:52 PM

Document Has Been Signed on 01/17/2024 05:09 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:PANDA CHILDREN'S CENTERFACILITY NUMBER:
384004609
ADMINISTRATOR:QI, WENFACILITY TYPE:
850
ADDRESS:2124 TARAVAL STREETTELEPHONE:
(415) 234-3096
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 5DATE:
01/17/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Wen QiTIME COMPLETED:
05:20 PM
NARRATIVE
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On 01/17/2024, at approximately 1:45 PM, Licensing Program Analysts (LPAs) Nasiripour and Van conducted an unannounced, annual inspection. LPAs met with Director Wen Qi, and explained the purpose of the inspection. Present in the facility are Director and one teacher, Wei Chen, caring for a total of 5 children, aged between 2-5 years old. All adults working in the facility are fingerprint cleared and associated to the facility. Facility is currently operating within teacher to child ratio on this date. The hours of operation are Monday-Friday from 8:00am to 6:00pm. LPAs conducted a health and safety hazard inspection.

LPAs observed multiple items specifically designed for infants: two cribs, one baby-rocker, one baby-bouncer, one baby-trainer toy that assists infants with walking, and one infant tummy-time mat. LPAs also observed 3 infant bottles equipped with devices meant to support gassy / colicky infants with milk or formula still inside of each bottle.

Storage for children's belongings is in the back of the facility, near the kitchen / food prep area, labeled with each child's individual names. Facility does not have updated Child Roster, leaving LPAs unable to verify children's storage is up to date.

LPAs observed facility has an installation of a fire alarm system, as well as a fully charged, fire extinguisher.

The facility has a smoke and carbon monoxide detector installed as well as one emergency kit with first aid materials, but no emergency contact information for children. Per Director, there are currently no children with medication enrolled at facility.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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 6
Document Has Been Signed on 01/17/2024 05:09 PM - It Cannot Be Edited


Created By: Yasha Nasiripour On 01/17/2024 at 04:03 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: PANDA CHILDREN'S CENTER
FACILITY NUMBER: 384004609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews and records reviews, it was revealed that the center did not comply with the above section. The Center failed to conduct lead testing of its water used for consumption before the January 1, 2023 deadline. Failing to complete the drinking water test for lead contamination levels could pose potential health and safety risks to the children in care.
POC Due Date: 02/16/2024
Plan of Correction
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The Director will contact the Certified Water Sampler to schedule a test of water fixtures used for water consumption for lead levels. A completed LIC 9275, LIC 9276, LIC999, and results of lead levels will be submitted to the Licensing office no later than the Plan of Correction due date.
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the Center did not comply with the section cited above, as the Center does not have proof that fire drills are being conducted and documented at least once every six months. Not conducting fire drills could pose/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 02/16/2024
Plan of Correction
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The Center will conduct a fire drill and log it by the due date of 2/16/2024. LPA will return to make sure the correction has been made.
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:Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 01/17/2024 05:09 PM - It Cannot Be Edited


Created By: Yasha Nasiripour On 01/17/2024 at 04:03 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: PANDA CHILDREN'S CENTER
FACILITY NUMBER: 384004609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review, the Center did not comply with the abovementioned section. S1 has not completed their Mandated reporter training, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 02/16/2024
Plan of Correction
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The Center Director must ensure that all current or new staff members complete the mandated reporter training every two years. The Center Director will have all staff complete the training by 2/16/2024. A return visit is necessary.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review, the Center did not comply with the section cited above. Neither the Director nor the teacher had complete immunization records. Records such as measles, pertussis, Influenza, and TB clearance were missing or not available for review, which poses/poses a potential health, safety, or personal rights risk for persons in care.
POC Due Date: 02/16/2024
Plan of Correction
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The Center must ensure that immunization records of all personnel are kept at the facility and available for review upon request. All staff members will have complete immunization available by 2/16/2024. A return visit is necessary.
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:Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024


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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: PANDA CHILDREN'S CENTER
FACILITY NUMBER: 384004609
VISIT DATE: 01/17/2024
NARRATIVE
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 Director reports that Facility has a plan to properly store Medication, which will be inaccessible to enrolled children and maintained with proper documentation in the Kitchen area, atop the refrigerator.

All poisons, cleaning solutions, and hazardous materials are not stored inaccessible to children but are in an off-limit area, located inside Staff Restroom. LPAs recommended Director to install child-safety latch for Staff Bathroom door.

The facility offers Breakfast, Snacks, and Lunch for all families. Water is available to children indoors. The facility has not completed Lead Testing. Children have their own physical space inside and outside. Children use mats for sleeping. Per Director, some children who are over 2 years old still use a crib, "sometimes but not really." Director reports they will remove cribs and learning equipment that is not age appropriate.

There is a variety of outdoor equipment that is in good working condition. Children are signed in and out of the facility through the Brightwheel App. The facility has license documentation and information properly posted and available for review in the entrance. There are no pools or bodies of water on the premises.

LPAs reviewed facility records of all children present, as well as records of both Director and Teacher. LPAs observed 3 out of 5 children's records were not complete. Both Director and Teacher have an up-to-date CPR & First Aid certificate. Teacher is not up to date with Mandated Reporter Training, but Director has valid Mandated Reporter Training, expiring 10/2024. The last emergency drill was conducted on 05/2023, but had no documentation available. LPAs instructed Director to conduct Emergency Drills at least once every six months and to properly log and document.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
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: PANDA CHILDREN'S CENTER
FACILITY NUMBER: 384004609
VISIT DATE: 01/17/2024
NARRATIVE
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Director was reminded that all adults 18 and over, 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 was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

The Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPAs encourages the Director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22- 02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
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: PANDA CHILDREN'S CENTER
FACILITY NUMBER: 384004609
VISIT DATE: 01/17/2024
NARRATIVE
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

CCC did not complete testing prior to their deadline. LPAs referred Director to the department Website for lead: Lead Toxicity Prevention and Water Testing Information.

The facility has been granted an outdoor waiver by the Department to allow a maximum of 9 children to utilize the playground at any given time. LPA observed that the outdoor waiver was posted accordingly. The facility uses a rotation schedule in the outdoor yard for play. The outdoor play area is well maintained, ensuring it is clean and free of any clutter that may pose a risk to the children's safety. Moreover, the playground is securely fenced. Additionally, soft cushioning material is placed beneath the play structures to minimize the chances of injuries from accidental falls. LPA also reminded the Director to check and clear any debris or harmful materials from the playground before use.

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

Based on today's inspection, deficiencies were observed, according to California Title 22, Health and Safety Code of Regulations. See LIC 809D for deficiencies cited today.

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

The exit interview conducted and report was reviewed with Director, Wen Qi.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Yasha Nasiripour
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC809 (FAS) - (06/04)
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