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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004563
Report Date: 12/20/2023
Date Signed: 12/20/2023 03:44:25 PM


Document Has Been Signed on 12/20/2023 03:44 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, JOYCEFACILITY NUMBER:
414004563
ADMINISTRATOR:WU, JOYCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 708-1788
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 7DATE:
12/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Joyce WuTIME COMPLETED:
03:50 PM
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On 12/20/2023 at 2:37PM., Licensing Program Analysts (LPAs) Luis J. Gomez and Melissa Zaragoza met with Licensee, Joyce Wu. Purpose of the inspection was explained and was for an unannounced, Plan of Correction inspection to review corrections made. Present was the licensee and helper caring 7 children (2 infant-age, 5 preschool-age). LPA inspected facility with licensee, for health and safety hazards.

During inspection, LPAs performed observations, record review, and interviews.

At 2:45PM., LPAs reviewed the children’s files and facility records. LPAs observed required Individual Infant Sleeping Plan (LIC9227) has been completed and stored in qualifying infant's file (C1).

LPAs reviewed infant napping logs, completed for the week of: 12/11/2023 – 12/15/2023. Licensee updated log during inspection.

Per licensee, the disaster drill was last conducted on 12/11/2023. LPAs reminded licensee to document each drill. Projected date for facility's next disaster drill is by: 6/11/2024.

During inspection, LPAs discussed approved courses for licensee's cardiopulmonary resuscitation / first aid certification. Licensee was advised to notify LPAs once appointment to renew CPR / 1st aid certification is made.

Deficiency issued on 12/7/2023, have been cleared and ‘Cleared Plan of Correction Letters’ were issued.

>No deficiencies were observed according to CCR, Title 22. Sec.12 Ch. 1.

Exit interview, plans for correction, and report was discussed with Licensee, Joyce Wu. Licensee signature on this form acknowledges receipt of these documents.



This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. Licensee was advised for additional questions to call Childcare Licensing Office, M-F, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023
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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