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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002515
Report Date: 03/15/2022
Date Signed: 03/15/2022 01:15:43 PM

Document Has Been Signed on 03/15/2022 01:15 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WU YEE CHILDREN'S SERVICES-POTRERO HILL CCC (PS)FACILITY NUMBER:
384002515
ADMINISTRATOR:OSMAN, YASMIN M.FACILITY TYPE:
850
ADDRESS:824 CAROLINA ST.TELEPHONE:
(415) 285-3600
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94107
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 10DATE:
03/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Yasmin OsmanTIME COMPLETED:
10:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Sheran Lo conducted an unannounced case management inspection and met with the Director Yasmin Osman. The purpose of the inspection was explained. Present in the facility were 7 teachers and 10 children in care.

Discussed during the inspection is the new law for Lead Testing of water in Licensed Child Care Centers Per AB2370. Due to the results our office received of higher level of parts per billion (ppb) allowed, Case Management inspection was conducted. Facility was proactive with getting facility faucets tested and fixed.

See next page for deficiency cited today.

Notice of site visit was provided for posting and must remain posted for 30 days.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2022
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 03/15/2022 01:15 PM - It Cannot Be Edited


Created By: Sheran Lo On 03/15/2022 at 09:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: WU YEE CHILDREN'S SERVICES-POTRERO HILL CCC (PS)
FACILITY NUMBER: 384002515

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/30/2022
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
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Facility has fixed affected faucet. They are in
waiting period with instruction on turning water
on for specific times each day before retesting
water. Retesting water is schedule for March
18, 2022.
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Based on results of lead testing of water, facility did not ensure to maintain level to be under 5 ppb, which poses a potential Health, Safety, and Personal Rights risk to persons in care.
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Facility will provide results after the water is
retested. Facility will provide forms required for
Self-Certification and Sampling Checklist.

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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Sheran Lo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2022


LIC809 (FAS) - (06/04)
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