<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004563
Report Date: 06/09/2025
Date Signed: 06/09/2025 12:53:14 PM

Document Has Been Signed on 06/09/2025 12:53 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/
DIRECTOR:		WU, JOYCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 708-1788
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
06/09/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Joyce WuTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 6/9/2025 at 9:15AM., Licensing Program Analyst (LPA), Luis Gomez and Ruhi Wadhwa met with Licensee, Joyce Wu. The purpose of today’s visit was explained and was for an unannounced, annual random inspection. Present was the licensee and assistant caring for 6 children. (4 infant-age, 2 preschool-age) Adults have criminal record clearances on file. Licensee’s home is a three bedroom, one bathroom, one level house. The days and hours of operations are: Monday- Friday, 8:00AM- 6:00PM. Areas of the home designated for childcare are: Living room (Playroom); Bedroom #1; Bathroom #1; and Backyard Area. Areas of the home designated as off-limits: Bedroom #2; Bedroom #3; Kitchen (Pass through only); Garage (Pass through only). LPA inspected facility indoors and outdoors for health and safety hazards.

At 9:20PM., the following was observed: Facility was clean with age-appropriate playthings available for the children.

At 9:30AM., Based on observation, LPAs confirmed exposed sharp cornered furniture, and basketball hoop without proper anchoring in bedroom #1 and Playroom.
At 9:35AM., Based on observation, LPAs confirmed loose blankets inside crib with napping infant.
At 9:37AM., Based on observation, LPAs confirmed infant-age child (C1), sleeping in bedroom #2 with the door closed.

The floors and ground surfaces were clear of any obstructions or hazards. For food services, LPAs observed table, chairs, scaled to the appropriate size.
LPAs observed infant feeding chair available in dining area.

LPAs reminded licensee to remove toy attachment from child (C1) pacifier. Advisory Note: Technical Violation (LIC9102TV) was issued.

For napping services, infant cribs are available in bedroom #2. Per licensee, napping supplies are washed weekly by families. Bathroom #1 was observed clean, with faucet and toilet in operating condition. Detergents, cleaning compounds, and item which can pose a danger, have been stored in the off-limit areas. Home was a comfortable temperature, ventilation, and lighting. Home has telephone and fire extinguisher (2A:10BC).
(REFER TO 809C, FOR CONT.)
Marie RodriguezTELEPHONE: (650) 266-8800
Luis GomezTELEPHONE: (650) 266-8800
DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2025
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 12
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 12
Document Has Been Signed on 06/09/2025 12:53 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/09/2025 at 10:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE
FACILITY NUMBER: 414004563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:40AM., Based on observation, LPAs confirmed climbing structure in backyard without absorbent material underneath slide. This poses a potential health and safety risk to children in care.
POC Due Date: 06/16/2025
Plan of Correction
1
2
3
4
Licensee will installed soft absorbent material under play structure by the due date: 6/16/2025.
Proof of correction will be submitted to the Department via email.
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:30AM., Based on observation, LPAs confirmed exposed sharp cornered furniture, and basketball hoop without proper anchoring in bedroom #1 and Playroom. This poses a potential health and safety risk to children in care.
POC Due Date: 06/11/2025
Plan of Correction
1
2
3
4
Licensee will anchor basketball hoop in playroom and cover sharp -corned furniture in playroom and bedroom #1 by the duet date: 6/11/2025.
Proof of correction will be submitted to the Department 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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (650) 266-8800
Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (650) 266-8800
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2025


LIC809 (FAS) - (06/04)
Page: 3 of 12
Document Has Been Signed on 06/09/2025 12:53 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/09/2025 at 10:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE
FACILITY NUMBER: 414004563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:35AM., Based on observation, LPAs confirmed loose blankets inside crib with napping infant. This poses a potential health and safety risk to children in care.
POC Due Date: 06/16/2025
Plan of Correction
1
2
3
4
Licensee will review PIN 20-24 CCP and implement safe sleep regulations (Remove all items from inside crib) by the due date: 6/16/2025.
Proof of correction will be submitted to the Department via email.
Type B
Section Cited
CCR
102425(j)(5)(A)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. The provider shall be able to visually observe the infant without moving the door.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:37AM., Based on observation, LPA confirmed infant-age child (C1), sleeping in bedroom #2 with the door closed. This poses a potential health and safety risk to children in care.
POC Due Date: 06/16/2025
Plan of Correction
1
2
3
4
Licensee will review PIN 20-24 CCP and implement safety sleep regulations (door open during nap time) by the due date: 6/16/2025.
Proof of correction will be submitted to the Department 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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (650) 266-8800
Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (650) 266-8800
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2025


LIC809 (FAS) - (06/04)
Page: 4 of 12
Document Has Been Signed on 06/09/2025 12:53 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/09/2025 at 10:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE
FACILITY NUMBER: 414004563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025

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 10:50PM., Based on record review, LPA confirmed individual infant sleeping plan (LIC9227) missing from facility files. This poses a potential health and safety risk to children in care.
POC Due Date: 06/16/2025
Plan of Correction
1
2
3
4
Licensee will ensure completed LIC9227, Individual infant sleeping plan is stored in children records by the due date: 6/16/2025. Proof of correction will be submitted to Department 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 11:00AM., Based on record review an interview, LPA confirmed licensee is not maintaining logs to document infant napping conditions after every 15 minute review. This poses a potential health and safety risk to children in care.
POC Due Date: 06/11/2025
Plan of Correction
1
2
3
4
Licensee will begin documenting infant napping conditions for children every 15 minutes by the due date: 6/11/2025.
Proof of correction will be submitted to Department 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.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (650) 266-8800
Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (650) 266-8800
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2025


LIC809 (FAS) - (06/04)
Page: 5 of 12
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: 06/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(PAGE 2)
At 9:35AM., LPAs inspected the outdoor play yard. Area was completed fenced, with plaything in good repair. Home does not have any pools; fishpond; jacuzzi; or other bodies of water.

At 9:40AM., Based on observation, LPAs confirmed climbing structure in backyard without absorbent material underneath slide.

At 10:10AM., LPAs reviewed facility records including the children and staff files. The children’s files were reviewed and included the: Identification and Emergency Information (LIC700); Notification of Parents Rights (LIC995); and Immunization Records.

At 10:50PM., Based on record review, LPAs confirmed individual infant sleeping plan (LIC9227) missing from facility files.
At 11:00AM., Based on record review an interview, LPAs confirmed licensee is not maintaining logs to document infant napping conditions after every 15 minute review.

Licensee’s cardiopulmonary resuscitation (CPR)/ Pediatric First Aid Certification was current, expiring: 12/2025.
LPA reminded licensee to renew required mandated reporter training (AB1207). Advisory Note : Technical Violation (LIC9102TV) was issued.

Facility is conducting emergency disaster drills every six months, with last drill completed on 5/3/2025. LPA reminded licensee to log disaster drills conducted on-site.
LPAs reminded licensee to ensure children's lunch containers are properly labeled. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 11:20AM., Based on observation, LPAs confirmed facility does not have functioning smoke/ carbon monoxide detector in facility.

The required forms are posted in entry and include the: License; and Written Emergency Disaster Plan (LIC610). Notice of parent rights form was posted during visit. Per licensee, isolation of an ill child is in the living room. Per licensee, facility provides daily snack for children. Parents provide meal services. (REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC809 (FAS) - (06/04)
Page: 12 of 12
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: 06/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(PAGE 3)
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.
LPA discussed safe sleep regulations with licensee and the 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.

Facility 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.(REFER TO 809C., FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC809 (FAS) - (06/04)
Page: 10 of 12
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: 06/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(PAGE 4)
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. An exit interview, plans for correction and facility evaluation report was discussed with Licensees, Joyce Wu.
Licensee’s signature of this form acknowledges the receipt of these documents.

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

LPA unable to print report during inspection. Copy of report will be sent to provider at a later date.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC809 (FAS) - (06/04)
Page: 9 of 12
Document Has Been Signed on 06/09/2025 12:53 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/09/2025 at 11:39 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, JOYCE
FACILITY NUMBER: 414004563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 11:20AM., Based on observation, LPAs confirmed facility does not have functioning smoke/ carbon monoxide detector in facility. This poses a potential health and safety risk to children in care.
POC Due Date: 06/11/2025
Plan of Correction
1
2
3
4
Licensee will install functioning smoke/ carbon monoxide detectors by the due date: 6/11/2025.
Proof of correction will be submitted to the department via email.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (650) 266-8800
Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (650) 266-8800
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2025


LIC809 (FAS) - (06/04)
Page: 11 of 12