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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004936
Report Date: 07/19/2023
Date Signed: 07/19/2023 01:44:28 PM

Document Has Been Signed on 07/19/2023 01:44 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: 9DATE:
07/19/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Qihua HuangTIME COMPLETED:
12:00 PM
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Licensing Program Analyst, LPA Yee conducted a follow up visit today. Present at the facility are the licensee, Qihua, 2 helpers, and 9 children. This visit is in regards to the citations cited on July 11th. Based on the information received and the observation from today's visit, the following citations have been corrected.

102416.5(b)(2): Staffing Ratio and Capacity: Today, the facility has 4 infants and 5 preschool age children.

102417(g)(8): Roster. The roster was received via email on 07-12-2023.

Therefore, deficiency cited on July 11th has been corrected.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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