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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002433
Report Date: 12/07/2021
Date Signed: 12/07/2021 12:12:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WU YEE CHILDREN'S SERVICES- BAYVIEW CDCFACILITY NUMBER:
384002433
ADMINISTRATOR:HARRIS-TOBIAS, BONNIEFACILITY TYPE:
850
ADDRESS:1601 LANE STREETTELEPHONE:
(415) 655-9567
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:32CENSUS: 13DATE:
12/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Bonnie Harris-TobiasTIME COMPLETED:
11:53 AM
NARRATIVE
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On December 7, 2021 at 10:30 AM, Licensing Program Analyst (LPA) Sheran Lo conducted a case management inspection and met with Center Manager Bonnie Harris-Tobias. Purpose of the inspection was explained to Manager. Present in the facility is 5 Staff supervising 13 preschool children.

Discussed during the inspection was related to the Unusual Incident Report the facility submitted November 22, 2021 of child leaving classroom and unsupervised. Manager states the child might have climbed over the gate and followed Manager out the hallway door unnoticed.

Based on interview with Manager and information obtained during the visit, lack of supervision was violated at the time of the incident.

*See next page of the deficiencies that were cited during visit today.*

This report was reviewed and emailed to Manager. The notice of site visit was given as well.

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran LoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: WU YEE CHILDREN'S SERVICES- BAYVIEW CDC
FACILITY NUMBER: 384002433
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/07/2021
Section Cited

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary...(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified... Supervision shall include visual observation.
This requirement is not met as evidenced by:
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Based on interviews, Director did not ensure to provide supervision at all times, which poses a potential Health, Safety, and Personal Rights risk to persons in care.
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Manager provided a copy of staff signing to acknowledgment of policy.

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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: Sheran LoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2021
LIC809 (FAS) - (06/04)
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