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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004563
Report Date: 07/09/2025
Date Signed: 07/09/2025 09:58:09 AM

Document Has Been Signed on 07/09/2025 09:58 AM - 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: 4DATE:
07/09/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Joyce WuTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On 7/9/2025 at 8:55AM., Licensing Program Analyst (LPA) Luis Gomez and met with Licensee, Joyce Wu. The purpose of inspection was explained and was for an unannounced, plan of correction inspection established on 6/9/2025. Present was the licensee and assistant caring for 4 child (2 infant-age, 2 preschool-age). LPA inspected facility for health and safety hazards.

During inspection, LPA conducted record review, observation, and interview.



At 9:00AM., LPA observed the following, basketball hoop, previously in playroom, has been removed. The sharp- cornered furniture in facility has been covered. LPA observed newly installed carbon monoxide/ smoke detector in living room was working order.

At 9:02AM., Based on observation, LPA confirmed loose blanket inside crib with napping infant-age child, C1.

LPA inspected the backyard area. LPA observed wood chips and foam padding had been installed underneath structure and slide.

At 9:25AM., LPA reviewed facility records. LPA observed required LIC9227, individual infant sleeping plan in qualifying child’s file, C5. LPA observed napping logs are being maintained for infant-age children in care (3).

During visit, six of seven deficiencies issues during annual inspection have been cleared, and 'letter of deficiency citation cleared' was provided to licensee.

Based on today's inspection, deficiencies were observed in area evaluated according to Title 22, California Code of Regulations (CCR, Title 22, Division 12, Chapter 3) are being cited on attached LIC9099D.

An exit interview, including plans for correction was discussed with Licensee, Joyce Wu. Licensee’s signature of this form acknowledges the 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 CCL Office, Mon-Fri, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

Marie RodriguezTELEPHONE: (650) 266-8800
Luis GomezTELEPHONE: (650) 266-8800
DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
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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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)
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Document Has Been Signed on 07/09/2025 09:58 AM - It Cannot Be Edited


Created By: Luis Gomez On 07/09/2025 at 09:40 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: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/10/2025
Section Cited

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102425(b) Safe Sleep: Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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At 9:02AM., Based on observation, LPA confirmed loose blanket inside crib with napping infant-age child, C1. This poses a 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.
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: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
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