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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506088
Report Date: 06/27/2023
Date Signed: 06/27/2023 03:44:22 PM


Document Has Been Signed on 06/27/2023 03:44 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:WU YEE CHILDREN'S SERVICES- PRESCHOOLFACILITY NUMBER:
380506088
ADMINISTRATOR:KAMEELAH DAVISFACILITY TYPE:
850
ADDRESS:177 GOLDEN GATE AVENUETELEPHONE:
(415) 321-3855
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:32CENSUS: 11DATE:
06/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Daisy Hsieh and Cindy HwangTIME COMPLETED:
04:00 PM
NARRATIVE
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On June 27, 2023, Licensing Program Analysts (LPAs) Van and Leong made an unannounced Case Management inspection and met with Regional Manager Daisy Hsieh and Center Manager Cindy Hwang. The purpose of the inspection was to follow up on an unusual incident at the Center that the Department received on June 20, 2023. The Facility self-reported an incident where C1 left the school and was found outside by a community ambassador.

According to the Regional Manager, the incident occurred during nap time when the children woke up. Per Regional Manager, C1 opened the door in the hallway, exited through the two front doors, and left the facility. C1 was found by a community ambassador and brought back to the Center. After the incident, the Center had all staff training on supervision and had a conference with the child’s family. In addition, staff members involved in the incident were dismissed from the Center.

Based on the interview and the incident report received on June 20, 2023, regarding the above incident, it was found that supervision was absent when the child left the site alone and walked outside the school without the teacher's knowledge. A $500 civil penalty was assessed today for the absence of supervision.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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 06/27/2023 03:44 PM - 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- PRESCHOOL
FACILITY NUMBER: 380506088

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision...children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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Immediate action was taken to correct this incident. On June 21, 2023, Regional Manager and Health Manager had all staff training on active supervision, accountability, and tracking policies, including headcount and face check. Training materials were provided to LPAs during the visit.
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This requirement is not met, as evidenced by the interview and facility incident report. The staff failed to provide adequate supervision, which allowed C1 to leave the facility and walk outside of the school without the staff's knowledge. This poses an immediate health and safety risk to children in care. A CIVIL PENALTY OF $500 WAS ASSESSED TODAY.
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POC cleared on 6/27/2023

A follow-up Informal Meeting is to be scheduled for a later date.

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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: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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