<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004936
Report Date: 01/18/2024
Date Signed: 01/18/2024 04:11:37 PM

Document Has Been Signed on 01/18/2024 04:11 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:HUANG, QIHUAFACILITY NUMBER:
414004936
ADMINISTRATOR:QIHUA HUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 718-9121
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
01/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Licensee, Qihua HuangTIME COMPLETED:
04:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/18/2024, at approximately 1:40PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Qihua Huang. LPA explained the purpose of the visit. Present during the visit was Licensee, Licensee’s spouse, a helper, three infants, and five preschool age children. The facility is in compliance with capacity requirements on this day. The facility’s operating hours are from 8:30AM to 5:30PM.

Daycare Areas: Living Room, Dining Area, Room #2 (Infant Napping Room), Room #3 (Playroom), and Backyard.
Off-limits Areas: Kitchen, Garage, Room #1, Room #4, Bathroom #2, and Front Yard.

LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged 3A40BC fire extinguisher. There is a combination smoke and carbon monoxide detector present in the Living Room. All electrical outlets are covered or obstructed by furniture to be inaccessible to children. There is a fireplace in the Living Room that is covered with a screen and additionally obstructed by furniture. Age-appropriate toys and learning materials are present in the Living Room and Playroom.

Bathroom #1 is separated from the Living Room by a childproof gate. LPA found that the drawers and cabinets in Bathroom #1 are free of detergents and other chemicals. Poisons, detergents, and other chemicals are stored inaccessible to children. The emergency exit route is posted in a visible area of the Living Room. Per Licensee, there are no firearms or weapons stored in the facility.

Room #2 is currently not in use as an infant napping room since children in care are able to climb out of cribs on their own. LPA observed four cribs in Room #2. Per Licensee, the room will only be used when needed for infants. Children who nap on cots bring blankets from home. Blankets are brought home to be washed once a week.
Continued on Page Two
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
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 5
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: HUANG, QIHUA
FACILITY NUMBER: 414004936
VISIT DATE: 01/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page Two
All off-limits areas are kept inaccessible to children by childproof gates or doorknob covers. LPA observed age-appropriate toys and equipment to be present in the Backyard. The Backyard is enclosed by a fence that is at least five feet high. There are no pools or other bodies of water present in the facility.

LPA reviewed three personnel files and eight children’s files. Licensee’s First Aid/CPR training is current and expires 6/2025. Licensee’s Mandated Reporter Training expires 7/2024. Immunization records for all personnel are available for review.

Upon review, LPA found that all children’s files were complete. Infant files included Individual Infant Sleeping Plan (LIC9227). Sleep logs are maintained digitally and are available for review for all infants present during today’s visit. Children’s files all included Emergency and Identification Information (LIC700), Consent for Emergency Medical Treatment (LIC627), Notification of Parents’ Rights (LIC995), Acknowledgement of Receipt of Licensing Reports (LIC9224) and current immunization records.

The facility provides breakfast, lunch, and AM/PM snacks for children in care. Tables and chairs for children are sanitized and cleaned after meals. Licensee has an active phone service available through a cell phone. All required postings are visible and accessible in the Living Room.

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.

Continued on Page Three
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: HUANG, QIHUA
FACILITY NUMBER: 414004936
VISIT DATE: 01/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page Three
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-andresources/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.

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/.

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

See LIC809-D for deficiency cited today.
Lee LIC9102-TV for Technical Violation given today.
A notice of site visit was given and must remain posted for 30 days.
Appeal rights were provided and explained.

Exit interview conducted and report was reviewed with the licensee, Qihua Huang.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/18/2024 04:11 PM - It Cannot Be Edited


Created By: Jonathan Tse On 01/18/2024 at 03:27 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: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2024
Plan of Correction
1
2
3
4
Licensee shall check Guardian for updates on their family member's fingerprint status. Licensee's family member is not to have contact with children in care until fingerprint clearance is granted. Licensee is to communicate any changes to clearance status to LPA by set due date of 1/31/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5