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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002679
Report Date: 10/03/2019
Date Signed: 10/03/2019 10:58:38 AM

COMPREHENSIVE INSPECTION
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:MAI, WENDY C. & LEE, JACK C.FACILITY NUMBER:
414002679
ADMINISTRATOR:MAI, WENDY C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 577-8880
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY:14CENSUS: 10DATE:
10/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH: Wendy Mai and Jack LeeTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Cowan met with Licensee, Wendy Mai and Jack Lee (son and helper). The purpose of the inspection was explained and was for Annual/Random inspection. Present in the facility is Licensee with helper caring for 3 infants and 7 toddlers. Licensee owns home, which is a 4 bedroom, 3 bathroom home and lives with son, Jack. Facility was inspected and Day care areas: living room, dining room, bathroom, bedroom (baby room), and backyard. Off limit areas: the entire second level and remaining areas on the lower level. All off limit areas are properly barricaded.

LPA observed the following:
Daycare area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has sufficient lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. (There is no fireplace nor stairs. Stairs are properly barricaded. There are no bodies of water or chimney in the Home. There are no poisons, detergents, or cleaning products accessible to day-care children. Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires 03/04/20. Licensee conducted last emergency drill on 09/02/19 and is properly logged. Licensee provides breakfast, lunch and one snack for children. Discipline policy is mainly redirection. All required postings are properly posted. Licensee has required proof of immunizations. Children’s files were reviewed and are complete and up to date.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MAI, WENDY C. & LEE, JACK C.
FACILITY NUMBER: 414002679
VISIT DATE: 10/03/2019
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During inspection,
Incidental Medical Services (IMS) policy was discussed.
Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was given information regarding ‘Safe Sleep’ practices.

> No deficiencies sited today

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
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