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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002385
Report Date: 09/01/2023
Date Signed: 09/01/2023 12:45:32 PM

Document Has Been Signed on 09/01/2023 12:45 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:YANG, MARICHU KHOFACILITY NUMBER:
414002385
ADMINISTRATOR:YANG, MARICHU KHOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 832-1558
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 14TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
09/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Marichu YangTIME COMPLETED:
01:00 PM
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On September 01, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon met with Licensee, Marichu Yang for an unannounced annual inspection. The purpose of the inspection was explained. Present today was Licensee, Licensee spouse, helper, and 2 infants. All adults present are fingerprint cleared and associated with facility. Licensee is operating within capacity and ratio requirements on this day. Hours of operation are Monday– Friday, 8:00 am - 6:00pm.

LPA and Licensee toured the home for health and safety hazards. Licensee owns this one-story home. Day Care Areas: Living room, dining room, kitchen, bedroom #2, bathroom, front yard, and backyard. Off Limits Areas: Bedroom #1, bedroom #3, bathroom #2. Home is well light and has proper ventilation. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. Fireplace in living room is properly barricaded with bench and screen and inaccessible to children. Toys are stored and rotated throughout the day for children to play. LPA observed playpens in napping room, parents provide sheet and are sent home weekly for washing. Backyard has a koi fish tank and aquarium which are properly covered and inaccessible to children in care. Entire backyard is fenced with a 5 ft fence. Front yard is not fenced, per Licensee she always supervises children when in front yard.

Home is equipped with a working carbon monoxide detector, smoke detector and a fully charged fire extinguisher. Isolation area for ill children will be in living room and away from other children. First aid kit is fully stocked with supplies. Licensee uses a cell phone on the premises. Per licensee there are no weapons or firearms in the home.

Cont. page 2…
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YANG, MARICHU KHO
FACILITY NUMBER: 414002385
VISIT DATE: 09/01/2023
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LPA reviewed 2 children’s records, which included LIC282, sleep logs and LIC9227. LPA reviewed helper records, Immunization records were missing, technical violation was issued. Licensee CPR/FA expires 09/2024. Licensee Mandated Reporter training expires 08/2024. Children bring their own food and snack. LPA reminded Licensee to label children's food/bottles brought from home. LPA reviewed children’s roster which is up to date. LPA observed Childcare License, Emergency Disaster Plan (LIC610A) and Parent's rights posted. Last emergency drill was conducted on 07/10/2023,

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.

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/.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee 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. LPA reviewed AB 1207 with the Licensee.

Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
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: YANG, MARICHU KHO
FACILITY NUMBER: 414002385
VISIT DATE: 09/01/2023
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As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com

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 [or facility representative] 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 discussed sleeping sacks and sleeping logs.

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 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 Marichu Yang confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

As of today, no deficiencies were issued under CCR, Title 22, Division 12.

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

Exit interview conducted and report was reviewed with the licensee Marichu Yang.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC809 (FAS) - (06/04)
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