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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004563
Report Date: 02/12/2020
Date Signed: 02/12/2020 10:44:45 AM

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, JOYCEFACILITY NUMBER:
414004563
ADMINISTRATOR:WU, JOYCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 708-1788
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 12DATE:
02/12/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Licensee, Joyce WuTIME COMPLETED:
10:10 AM
NARRATIVE
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Licensing Program Analyst (LPA), Luis J. Gomez met with licensee, Joyce Wu. Purpose of inspection was explained and is for a plan of correction inspection. Present is licensee, helper caring for 12 children. ( Six infants Six Preschool Age). LPA Gomez inspected the facility with licensee for health and safety hazards. The following deficiency from the previously inspection was checked today:

-102416.5 Ratio and Capacity

At 9:10am on February 12, 2020 LPA Gomez preformed facility observations. At 10:00am on February 12, 2020 LPA Gomez observed 6 infants in care in the facility.

**deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1 and cited on 809-D**

Copy of LIC 9224 was provided to licensee. Deficiency and Acknowledgment of Receipt of Licensing Reports (LIC 9224) must be given to all parents (current and new/incoming parents for the next 12 months) for all parents to sign and return. Signed forms must be maintained in child's folder for review.

>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) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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: WU, JOYCE
FACILITY NUMBER: 414004563
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2020
Section Cited

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102416.5 Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by.
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Based on observations conducted, facility record review and parent interviews, LPA Gomez confirmed facility operating out of ratio. This is an immediate health and safety risk to children in care
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Type A
02/13/2020
Section Cited

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Conduct of Inimical:Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state. The requirment is not met as evidenced by.
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Based on facility file review and interviews conducted, LPA confirmed licensee submitted false documents, displaying children's date of birth. This poses an immidate health and safety risk to children in care.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2020
LIC809 (FAS) - (06/04)
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