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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005075
Report Date: 01/18/2024
Date Signed: 01/18/2024 11:16:28 AM

Document Has Been Signed on 01/18/2024 11:16 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:HUANG, QI PINGFACILITY NUMBER:
414005075
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/18/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Applicant, Qi Ping HuangTIME COMPLETED:
11:30 AM
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On 1/18/2024, at approximately 8:30AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an announced prelicensing visit at the address listed above. LPA was granted entry to the home by Applicant, Qi Ping Huang. LPA explained the purpose of the visit. Present during the visit was the Applicant. All adults living or working in the home have acquired fingerprint clearance and are associated to the assigned facility number.

Daycare Areas: Living Room, Dinner Room, Breakfast Room, Hallway, Bathroom #1, and Bedroom #1.
Off-limits Areas: Upper Level: Kitchen, Bedroom #2, Bathroom #2, Bedroom #3.
Lower Level: Bedroom #4, Bathroom #3, Garage, Storage #1, Storage #2, and Backyard.

LPA and Applicant 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 2A10BC fire extinguisher. There are four combination smoke and carbon monoxide detectors in the home that were demonstrated to be operational. LPA observed the Living Room, Dinner Room, and Breakfast Room to be clean and orderly. Per Applicant, the Living Room is intended for preschool age children and the Dinner Room is for infants. There is a diaper changing station set up in the Dinner Room.

The Kitchen is secured by childproof gates. Bathroom #1 was observed to have childproofed cabinets. Bedroom #1 is used as a napping room for children. LPA observed four cribs present in Bedroom #1. All four cribs are equipped with mattresses and tight-fitted sheets. Bedrooms #2 and #3 are designated as off-limits. LPA did not observe health or safety hazards in the Bedrooms. Per Applicant, there are no firearms or weapons in the home.


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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
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: HUANG, QI PING
FACILITY NUMBER: 414005075
VISIT DATE: 01/18/2024
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There are stairs in the Breakfast Room that lead to the lower level. The door to the stairs is secured with a childproof cover on the doorknob. The lower level consists of Bedroom #4, Bathroom #3, the Garage, Storage Areas #1 and #2, and the Backyard. The Backyard is not fully furnished with cushioning and age-appropriate toys/equipment. Per Applicant, she does not intend to use the Backyard until it is complete. The entire lower level will remain as off-limits until sufficient cushioning (artificial turf) and gates are installed in the Backyard.

Applicant plans to operate from 8:30AM to 5:30PM. Applicant intends to enroll children from the ages of 0 to 5. Applicant will prepare breakfast, lunch, and afternoon snack for children in care. Sheets will be provided, and children will bring blankets from home for napping. Blankets and sheets will be washed once a week.

Applicant’s First Aid/CPR is current and expires 11/2025. Applicant’s Mandated Reporter Training is current and expires 1/2026.

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.
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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)
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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: HUANG, QI PING
FACILITY NUMBER: 414005075
VISIT DATE: 01/18/2024
NARRATIVE
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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.

On this date, 01/18/2024, 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.

Prior to licensure, the following must be completed by 1/31/2024:
1) TB clearance for spouse must be submitted.
2) Photos of fully furnished daycare areas.

Exit interview conducted and report was reviewed with the applicant, Qi Ping Huang.

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: 01/18/2024
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)
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