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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004563
Report Date: 02/28/2020
Date Signed: 02/28/2020 11:09:10 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: 9DATE:
02/28/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Joyce WuTIME COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst (LPA), Luis J. Gomez met with licensee, Joyce Wu. Purpose of the inspection was explained and is for an annual inspection. Present in the facility is the licensee and helper caring for nine children. (Three preschool age, Six infant age). At 9:39am on February 28, 2020, LPA Gomez observed a licensee is over capacity, with five infants in care, in the facility. Licensee’s home is a three - bedroom, one -bathroom, one story house. Hours of Operation are: Monday- Friday: 8:00am- 6:00pm. Daycare areas: Living Room (Playroom), Bedroom #1 (Napping Room), Bathroom #1 and Backyard Area. Off Limit areas are: Bedroom #2, Bedroom #3, Garage (Pass through only), Hallway (Pass through only) and Kitchen. LPA inspected home with licensee for health and safety hazards.

At 8:30pm on February 28, 2020, LPA inspected Living room, Bedroom #1 and Bathroom #1. Day-care area is clean, orderly has a variety of age appropriate books, games and toys for the children. All furniture and children's playthings are in good repair. Licensee has child size tables and chairs for meals and activities. Facility is the proper temperature, with ventilation and natural lighting. The fireplace, located in the living room, is properly barricaded. All off-limit areas are made inaccessible with use of locked doors and child safe gates. All cleaning supplies, poisons and other chemicals are stored inaccessible to children. Bedroom #1, located in facility hallway, has several cribs available for daycare children. All outlets and trash cans are covered. Bathroom #1, located in the hallway, is maintained clean with adequate supplies. Home does not have a swimming pool, spa, hot tub, fishpond or any other bodies of water.

At 9:00am on February 28, 2020, LPA inspected the outdoor play area. LPA observed outdoor play area is completely enclosed. Licensee has installed a play structure, soft turf carpeting and a grass area for additional safety. Home has a functioning home phone, smoke, carbon monoxide detector combo and a fully charged fire extinguisher (2A:40BC), located in the kitchen. (Continuation on 809-C)
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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
VISIT DATE: 02/28/2020
NARRATIVE
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(Continuation, Page 2)
At 9:15am on February 28, 2020 LPA reviewed children’s files and facility files. At 9:22am on February 28, 2020 LPA observed licensee is not conducting or logging emergency disaster drills every six months. Licensee’s CPR/ 1st aid certification is current expiring: 02/2021. Facility license, emergency disaster plan and parent's rights are properly posted in the day-care. Per licensee, she takes the children to the park. Per licensee, parents provides lunch and snack for the children. Licensee stated there are no guns or weapons in the home.

Incidental Medical Services (IMS) was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

During inspection,
· Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
· Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and plan of correction was dicussed with, Joyce Wu, and her signature of this form acknowledges receipt of these documents.



>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 inspection was posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 02/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited

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102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. This requirement is not met as evidenced by.
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Based on interview with licensee and a facility file review, LPA confirmed licensee is not conducting or documenting emergency disaster drills every six months. This is a potential health and safety risk to children in care.
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Licensee will submit proof of correction to LPA Gomez via email

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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: 02/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3