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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005070
Report Date: 01/31/2024
Date Signed: 01/31/2024 10:27:49 AM

Document Has Been Signed on 01/31/2024 10:27 AM - 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:WU, TINGLINFACILITY NUMBER:
414005070
ADMINISTRATOR:WU, TINGLINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 307-9911
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
01/31/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Applicant, Tinglin WuTIME COMPLETED:
10:45 AM
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On 1/31/2024, at approximately 8:30AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an announced prelicensing visit for a change of location. LPA was granted entry to the facility by Applicant, Tinglin Wu. LPA explained the purpose of the visit. Present during the visit was the Applicant and Applicant’s preschool age child. The facility’s hours of operation will be 8:30AM to 5:30PM, Monday to Friday.

The home is a two-story, three-bedroom, one-bathroom home.
Daycare Areas: Lower level: Living Room, Kitchen, and Backyard.
Upper level: Bedroom #1 (Baby Bedroom), Bedroom #2 (Playing Room), and Bathroom.
Off-limits Areas: Bedroom #3 and Garage.

LPA inspected the home for any health or safety hazards. LPA observed the home to be in clean and orderly condition. The home is equipped with a smoke detector and a carbon monoxide detector that is operational. There is a fully charged 2A10BC fire extinguisher. LPA observed age-appropriate toys and learning equipment in the Living Room. Electrical outlets are covered or obstructed by furniture to be inaccessible to children in care. Cabinets and drawers in the Kitchen are secured by childproof locks. Per Applicant, they will provide breakfast, lunch, and snack to children in care. All off-limits areas are kept inaccessible by childproof doorknobs.

Bedroom #1 was observed to have one crib present. LPA discussed safe sleep regulations with Applicant. Applicant is aware of the requirement to check on sleeping infants every 15 minutes and that they must be on the same floor. LPA observed Bedroom #2 to be equipped with age-appropriate toys and equipment. Cleaning detergents, chemicals, and poisons are stored inaccessible to children. Per Licensee, there are no firearms or weapons present in the home.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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: WU, TINGLIN
FACILITY NUMBER: 414005070
VISIT DATE: 01/31/2024
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LPA observed the Backyard to be free of debris and other loose articles. The Backyard is enclosed by a fence that is at least five feet high. There is a sandbox present in the Backyard that is covered. There are age-appropriate toys and equipment. Cushioning is available in the form of mats. There are no pools or other bodies of water located in the facility.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the
ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
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: WU, TINGLIN
FACILITY NUMBER: 414005070
VISIT DATE: 01/31/2024
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On this date, 01/31/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Applicant initially applied for a change in capacity in addition to a change of location. During the visit, Applicant declared that they did not wish to proceed with a change of capacity, opting to continue only with the change of location.

LPA will recommend licensure of this facility as a Small Family Child Care Home. LPA discussed the application procedure for a change of capacity with the Applicant in the case that they decide to pursue it again. Applicant understood.

Exit interview conducted and report was reviewed with the applicant, Tinglin Wu.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
LIC809 (FAS) - (06/04)
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