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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004563
Report Date: 01/22/2020
Date Signed: 01/22/2020 11:32:26 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2020 and conducted by Evaluator Luis Gomez
COMPLAINT CONTROL NUMBER: 05-CC-20200115154456
FACILITY NAME:WU, JOYCEFACILITY NUMBER:
414004563
ADMINISTRATOR:WU, JOYCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 708-1788
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 11DATE:
01/22/2020
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Joyce WuTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Licensee is operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Luis J. Gomez met with Joyce Wu for complaint investigation of above allegation. Purpose of the inspection was explained. Present is the licensee and helper caring for 11 children. (Eight infant age and three preschool age). On January 22, 2020 LPA Gomez observed licensee is operating out of ratio. LPA Gomez inspected facility with licensee for health and safety hazards.

During today's inspection LPA Gomez interviewed licensee, performed observations, reviewed facility records.

As part of this investigation, LPA Gomez conducted inspections of the facility on 1/22/2020. A review of facility records was also completed, which included a review of the children’s roster, personnel files and children's files. Also, as part of this complaint investigation, interview was conducted with the licensee.

(Continuation on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 05-CC-20200115154456
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/22/2020
NARRATIVE
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(Page 2)
Regarding the allegation of licensee is operating out of ratio. Based on facility observations conducted on 1/22/2020, review of children's files and children's roster, LPA confirmed licensee is operating out of ratio. During inspection, LPA observed eight infants age and three preschool age children in care.

Therefore, The preponderance of evidence standard has been met, there for the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, section 12 & chapter are being cited on the attached 9099-D

Exit interview was conducted with Joyce Wu and plan of correction was developed with the licensee. LPA observed notice of site visit was posted in the facility.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 05-CC-20200115154456
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/22/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2020
Section Cited
CCR
102416.5(a)
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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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Licensee will reduce her registered infants to the required limit (Four). Licensee will submit a children's schedule, showing the dates and time's each child is scheduled to be in care by the due date: 01/23/2020

Licensee will submit proof of correction to LPA Gomez via email.
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Based on observations conducted, review of the children's roster and a record review, LPA Gomez confirmed facility operating out of ratio. This is an immediate health and safety risk to children in care.
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Infants Pre K School Age
4 7 0
3 8 0
3 9 2
2 10 2
1 11 2


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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: 01/22/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4