414004563-12-7-2023-05-CC-LGOZ-CYAW3N-20231207155612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004563
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:56:31 PM

Document Has Been Signed on 12/07/2023 03:56 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	WU, JOYCE		FACILITY NUMBER:	414004563
ADMINISTRATOR:	WU, JOYCE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 708-1788
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	14	CENSUS: 7	DATE:	12/07/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Joyce Wu		TIME COMPLETED:	04:10 PM

NARRATIVE

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On 12/7/2023 at 1:10PM., Licensing Program Analysts (LPAs), Luis J. Gomez and Janet Gil met with Licensee, Joyce Wu. Purpose of the inspection was explained and was for an Unannounced; Annual Random. Present was the licensee and helper caring for 7 children (2 Infant-age, 5 Preschool- age). Adults present have criminal record clearances on file. Licensee’s home is a 3 bedroom, 1 bathroom, 1 level house. Days and hours of operations are: Monday- Friday, 8:00 AM., to 6:00 PM. Daycare areas: Living Room (Playroom), Bedroom #1 (Napping Room), Bathroom #1 and Backyard Area. Off Limit areas: Bedroom #2, Bedroom #3, Garage (Pass through only), Hallway (Pass through only) and Kitchen. LPAs inspected home with licensee for health and safety hazards.

At 1:15PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Ground surfaces were clear of obstructions. Furniture, toys, and items inspected were in good repair. Child sized tables and two chairs for seated activities. For napping services, LPA observed mats and cribs located in bedroom #1. Crib was available for each infant in care. Fireplace had been barricaded.

LPAs reminded licensee to remove baby bouncer from facility. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPAs reminded licensee to ensure infant napping sheets are washed weekly, and maintain cribs free of loose articles. Advisory Note: Technical Violation (LIC9102TV) was issued.

Bathroom #1 was maintained clean with supplies for hand washing. Facility was a comfortable temperature, with adequate ventilation and lighting. Off-limit areas are made inaccessible with child safety gates. Home had functioning telephone service; smoke/ carbon monoxide combination detector; and fire extinguisher: 2A:10:BC.

At 1:25PM., LPA inspected the outdoor play yard. Yard was enclosed with tall fencing, with playthings in good repair. Play structure was anchored, with absorbent material and turf installed or added safety. Home does not have any pools, fishponds, jacuzzi and bodies of water. (REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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 12/07/2023 03:56 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE	FACILITY NUMBER: 414004563
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 2:00PM., Based on interview and record review, LPAs confirmed licensee has not documenting required disaster drill, done every six months. This poses a potential health and safety risk to children in care.
	POC Due Date: 12/15/2023
	Plan of Correction
1 2 3 4	Licensee will conducted and document a disaster drill with children in care, by the due date: 12/15/2023. Proof of correction will be submitted to the LPA, via email.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 2:05PM., Based on record review, LPAs confirmed licensee's Cardiopulmonary Resuscitation/ 1st Aid Certification has expired. This poses a potential health and safety risk to children in care.
	POC Due Date: 12/22/2023
	Plan of Correction
1 2 3 4	Licensee will complete CPR/ 1st aid certification course by the due date: 12/22/2023. Proof of correction will be submitted to the LPA via email.

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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/07/2023 03:56 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE	FACILITY NUMBER: 414004563
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:52PM., Based on record review and interview, LPAs confirmed Individual Infant Sleeping Plan (LIC9227) was missing from qualifying infants (C1) file.
	POC Due Date: 12/11/2023
	Plan of Correction
1 2 3 4	Licensee will have family complete the required LIC9227, Individual Infant Sleeping Plan by the due date: 12/11/2023. Proof of correction will be submitted to the LPA via email.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:50PM., Based on record review, and interview, LPAs confirmed licensee is not documenting infant napping conditions every 15 minutes. This poses a potential health and safety risk to children in care.
	POC Due Date: 12/11/2023
	Plan of Correction
1 2 3 4	Licensee will begin to document each review of napping infants in care. Proof of correction will correction to the LPA via email.

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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

Page: 3 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE	FACILITY NUMBER: 414004563
	VISIT DATE: 12/07/2023

NARRATIVE

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(Page 2)
At 1:35PM., LPAs reviewed facility records including 7 children’s files and the staff files.

At 1:40PM., Based on record review and interview, LPAs confirmed helpers, S1, 'Mandated Reporter Certification' (AB1207), and Proof of required Immunization were missing from facility files. Advisory Note: Technical Violations (LIC9102TV) was issued.

Children’s files were reviewed and included the: Identification of Emergency Information (LIC702); Notification of Parent’s Rights; and Immunization Records.

At 1:50PM., Based on record review, and interview, LPAs confirmed licensee is not documenting infant napping conditions every 15 minutes.
At 1:52PM., Based on record review and interview, LPAs confirmed Individual Infant Sleeping Plan (LIC9227) was missing from qualifying infants (C1) file.

At 2:00PM., Based on interview and record review, LPAs confirmed licensee has not documenting required disaster drill, done every six months.
At 2:05PM., Based on record review, LPAs confirmed licensee's Cardiopulmonary Resuscitation/ 1st Aid Certification has expired.

Required forms observed posted in playroom included the: Childcare License and Emergency Disaster Plan (LIC610A). Licensee posted the Notification of Parent’s Rights (PUB379) during today's inspection.

Licensee’s children's roster (LIC9040) was reviewed during inspection.

Per licensee, isolation of an ill children is in the playroom.

Per licensee, she provides food service for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled. Per licensee, home does not have any firearms.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

Page: 9 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE	FACILITY NUMBER: 414004563
	VISIT DATE: 12/07/2023

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(Page 3)
LPAs discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for IMS must be submitted to the department. the following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514-0301 (voice)/ (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations and cited on 809D. Exit interview, Appeal rights, Plan for Correction and Report was conducted with licensee, Joyce Wu. Licensee’s signature of this form acknowledges receipt of these documents.

During exit interview, Licensee, Joyce Wu, confirmed that no registered sex offenders are living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

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