384004621-1-22-2024-05-CC-SLOO-CZQT9W-20240122133237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004621
Report Date: 01/22/2024
Date Signed: 01/22/2024 01:33:08 PM

Document Has Been Signed on 01/22/2024 01:33 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:	ZULHENDRI, FELICIA AND SIMAN, SUDHARMONO		FACILITY NUMBER:	384004621
ADMINISTRATOR:	ZULHENDRI, FELICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 638-9071
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94107
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	01/22/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Felicia Zulhendri and Sudharmono Siman		TIME COMPLETED:	01:48 PM

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On January 22, 2024, Licensing Program Analyst (LPA) Sheran Lo arrived at the facility to conduct an unannounced Annual Inspection on this day and met with the Licensees Felicia Zulhendri and Sudharmono Siman . Purpose of the inspection was explained. Present there were 10 children in care with Licensees. Licensee was operating in compliance to the required licensed capacity and ratio limits as of today. Per Licensee, the two bedroom apartment is rented and living at home are Licensees and minor daughter. LPA verified the background check clearance of the adults working or living in the home. The hours of operation are: M-F, 8:30 AM – 4:45 PM. Licensee provides snacks and children bring their own lunch from home.

Daycare areas: First Floor Unit: Living Room, Dining Room, Bedroom 2, Bathroom 2, and Back Patio. Off Limit areas: Bedroom 1, Bathroom 1, and Storage rooms. LPA and Licensee inspected the entire child care area for Health and Safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There was a combined carbon monoxide and smoke detector in the home. LPA performed the tests to check the functionality of the detector. A fire extinguisher of size 2A10BC or bigger was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there are no firearms or weapons in the home. Licensee states, there are no bodies of water and no pets in the home.

LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation. LPA observed that there is a variety of age appropriate toys, books and other learning material available in the home for the children in care. Electric outlets have been secured with child protective covers, and a working phone is on site. Per Licensee, Discipline policy is positive guidance or communicate about appropriate behavior practice.

All posting requirements are met and posted near the child care entrance. Licensee has current and valid CPR and First Aid card expiring on 1/2026.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ZULHENDRI, FELICIA AND SIMAN, SUDHARMONO	FACILITY NUMBER: 384004621
	VISIT DATE: 01/22/2024

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LPA reviewed facility records including all children's files present today. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative.

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.

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-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.

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-care-centers/.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ZULHENDRI, FELICIA AND SIMAN, SUDHARMONO	FACILITY NUMBER: 384004621
	VISIT DATE: 01/22/2024

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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, the LICENSEE Felicia Zulhendri and Sudharmono Siman, 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 licenseeFelicia Zulhendri and Sudharmono Siman .

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC809 (FAS) - (06/04)

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