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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004936
Report Date: 07/11/2023
Date Signed: 07/11/2023 01:05:54 PM

Document Has Been Signed on 07/11/2023 01:05 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:HUANG, QIHUAFACILITY NUMBER:
414004936
ADMINISTRATOR:QIHUA HUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 718-9121
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
07/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Qihua HuangTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst, LPA Yee conducted a case management inspection today. Present at the facility are the licensee, Qihua, licensee's husband, helper, Lorena, and 11 children (5 infants). LPA reviewed the children's records and found that the facility has 5 infants in care. The facility needs to correct this deficiency by the next business day. A capacity worksheet for large FCCH was explained and provided.

Regulations were explained to Licensee. large FCCH. with helper
0-24months 2-school age school age(k-6yrs)
4 8 0
3 9 2
2 10 2
1 11 2
0 12 2



See next page for Type A citation. The facility was advised to post and provide copies of this report to parents and guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents shall sign the LIC 9224 as proof of receipt. Appeal Rights was provided.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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Document Has Been Signed on 07/11/2023 01:05 PM - It Cannot Be Edited


Created By: Jennifer Yee On 07/11/2023 at 12:06 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: HUANG, QIHUA
FACILITY NUMBER: 414004936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/12/2023
Section Cited
CCR
102416.5(b)(2)

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(b)A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:
At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
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LPA provided licensee with capacity worksheet and explained to licensee. Licensee said she understands. Licensee needs to adjust children's schedule to meet capacity requirement of a large family child care home license. LPA will conduct a follow up inspection to verify the correction. If deficiency is not corrected, civil penalties will be issued
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Based on observation, interview and record review the licensee did not comply with the section cited above. LPA observed 5 infants (under 24 months) and 6 preschool age (over 24 months) children in care, which poses an immediate health, safety or personal rights risk to persons in care.
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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:Jennifer Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2023 01:05 PM - It Cannot Be Edited


Created By: Jennifer Yee On 07/11/2023 at 12:32 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: HUANG, QIHUA
FACILITY NUMBER: 414004936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2023
Section Cited
CCR
102417(g)(8)

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Roster: 102417(g)(8):Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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The licensee needs to submit the roster by 07/18/2023. She said she understands
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This requirement was not met as evidence-based upon records review and the licensee failed to meet the requirement. This poses a potential health risk to children in care.
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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:Jennifer Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
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