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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505707
Report Date: 11/28/2023
Date Signed: 11/28/2023 10:42:21 AM


Document Has Been Signed on 11/28/2023 10:42 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:WU YEE CHILDREN'S SERVICES-GENERATIONS CDCFACILITY NUMBER:
380505707
ADMINISTRATOR:HWANG, CINDYFACILITY TYPE:
850
ADDRESS:1010 MONTGOMERY STREETTELEPHONE:
(415) 529-1345
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94133
CAPACITY:23CENSUS: 11DATE:
11/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Daisy HsiehTIME COMPLETED:
11:00 AM
NARRATIVE
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On November 28, 2023, at approximately 9:00am, Licensing Program Analyst (LPA) Ly conducted a Case Management Inspection at the facility due to a self reported incident that happened on 10/13/2023 and was brought to the attention of the Facility's Administrators on 10/17/2023. Incident was reported by phone to Licensing on 10/17/2023 and followed with a written report from facility representative. During today's visit, LPA met with facility Regional Manager Daisy Hsieh. There were 11 children and 5 staff including the Regional Manager present during today's visit.

During today's visit, LPA interviewed Regional Manager regarding the self reported Unusual Incident. The involved staff was placed on Administrative Leave pending internal investigation and was later terminated from the facility.

Based on interview and information collected, facility staff violated the children's personal rights. Type B deficiency is being cited today in accordance with the California Code of Regulations, Title 22, see LIC 809D.

Plans of Corrections (POC) were developed and reviewed with Regional Manager. A copy of this report was discussed and left with Regional Manager whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to licensee. Regional Manager was advised Notice of Site Visit to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
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 11/28/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: WU YEE CHILDREN'S SERVICES-GENERATIONS CDC
FACILITY NUMBER: 380505707

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2023
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement has not been met as evidenced by:
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Based on Interview, Regional Manager stated trainings have been conducted with staff. One of the Trainings Agendas included Children's Personal Rights.
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Based on interview collected during today's visit, the involved staff had violated the children's personal rights which poses a potentital health and safety risk to children in care.
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Regional Manager will email to LPA proof of trainings provided to staff by due date 12/05/2023.

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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
LIC809 (FAS) - (06/04)
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