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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004864
Report Date: 02/13/2025
Date Signed: 02/13/2025 04:25:59 PM

Document Has Been Signed on 02/13/2025 04:25 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:XIONG, XIAO QINGFACILITY NUMBER:
414004864
ADMINISTRATOR/
DIRECTOR:		XIONG, XIAO QINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 383-2886
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/13/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:04 PM
MET WITH:Xiao Qing XiongTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On February 13, 2024 @ approx. 2:05 pm, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced annual inspection and met with Licensee, Xiao Qing Xiong. LPA explained the purpose of the inspection. Present during today's visit was Licensee, helper and 9 children (3 infant and 6 preschool age). Facility is operating within capacity/ratio limits. All adults present have criminal background clearance and associated with facility. Hours of operation are Monday– Friday, 8:00 am – 6:00 pm.

LPA and Licensee toured the inside and outside of home for health and safety hazards. Home is a two-story level home. Day Care Areas: entrance foyer/hallway, living room (main daycare area), dining room, bedroom #1 (napping only), bathroom and backyard. Off-Limits Areas: Kitchen, garage, and entire second level of home. Isolation Area: dining room and away from other children. Living room is equipped with two retractable child proof gates between living room and kitchen and living room and entrance foyer. Staircase is equipped with a retractable child proof gate. Fireplace located in dining room is barricaded with a glass door and equipped with a child proof latch. Bathroom cabinet is equipped with a child proof latch, LPA reminded Licensee to store all cleaning supplies, technical assistance provided. LPA observed all electrical outlets to be covered with furniture and outlet covers. Flooring in living room is equipped with interlock foam tile mats to cushion falls. Home is clean, well light and has proper ventilation. Cleaning supplies and other potentially harmful items are stored inaccessible to children and behind child proof cabinets. There are plenty of age-appropriate toys, books, child size furnishings, learning materials, changing tables. sleeping mats, and cribs. Licensee provides sheets for mates and cribs and laundered on a weekly basis or as needed. Backyard has plenty of age-appropriate toys, which includes play slide structures, playhouses, and ride on toys, all in good condition. Backyard flooring is a cement patio and artificial grass to cushion falls. Backyard is completely fenced off with a 5 ft. wood fence. LPA did not observe any pool, spas, or other bodies of water.

Home is equipped with a working carbon monoxide detector, smoke detector and a fully charged fire extinguisher which is in stored in closet next to bathroom. LPA reviewed first aid kit and kit is fully stocked. Licensee uses cell phone on the premises and understands phone must remain on premises during childcare hours. Licensee provides breakfast, lunch and afternoon snacks to children in care. LPA reminded licensee to label children's food/bottles brought from home. 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: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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 7
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: XIONG, XIAO QING
FACILITY NUMBER: 414004864
VISIT DATE: 02/13/2025
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LPA reviewed 5 children’s files and 1 staff file. One child’s record was missing LIC627, technical violation issued. Technical assistance was issued for helper missing Mandated reporter training. LPA reminded Licensee of maintaining 15-minute sleep logs for all children under 24 months of age, technical violation issued. Licensee’s CPR/First aid expires 02/2027. Licensee mandated reporter training ex. 11/2026. LPA observed Childcare License, Emergency Disaster Plan (LIC610A), Earthquake Preparedness (LIC9148) and Parent's Rights. Last emergency drill was conducted on August 1, 2024, and is properly documented. Per License, liability insurance is via Next insurance.

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.

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

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

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: XIONG, XIAO QING
FACILITY NUMBER: 414004864
VISIT DATE: 02/13/2025
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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-and-resources/safe-sleep as an additional resource. LPA also informed licensees 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 the ban of sleep sacks.

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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, LICENSEE Xiao Qing Xiong confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



No deficiencies were issued at the time of LPA’s visit, in accordance with Title 22 regulations.

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

Exit interview conducted and report was reviewed with the Licensee, Xiao Qing Xiong.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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