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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701315
Report Date: 06/30/2026
Date Signed: 06/30/2026 03:47:08 PM

Document Has Been Signed on 06/30/2026 03:47 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WU, CAIQUNFACILITY NUMBER:
015701315
ADMINISTRATOR/
DIRECTOR:		CAIQUN WUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 813-0213
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY: 12TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
06/30/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:23 AM
MET WITH:Caiqun Wu- LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 6/30/26 at 10:23am, Licensing Program Analyst Briana Plumboy, met with licensee Caiqun "Krystal" Wu for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was 6 infants, 2 preschool age children, and licensee. The license is approved for a capacity of 14 children. The licensee stated there are 8 children enrolled, attending at various times. LIC 126 was provided to the licensee by LPA Plumboy. The home was toured with licensee to conduct a Health and Safety Inspection. Hours of operation for day care are Monday through Friday, 8:30am- 5:30pm. At 12:22pm, LPA Jyoti Saini arrived at the facility.

The home is single story. The home consists of the following rooms: 3 bedrooms, 1 bathroom, living room, garage, kitchen, and dining room. The home is neat and clean with heating and ventilation for safety and comfort. The licensee has requested the OFF LIMIT AREAS BE: the bedroom on the right side of the hallway, the kitchen, and the garage which will be inaccessible by closed and/or locked doors and visual supervision. The licensee has requested the following rooms be ON LIMITS - the two bedrooms on the left side of the hallway, the hallway bathroom, the living room, the dining room, and the patio area in the backyard which has artificial turf and a child safety gate surrounding it during todays inspection. The ISOLATION AREA will be the the dining room area. BACKYARD play area is completely fenced. The licensee will not use the grass areas inside the backyard, or the sides of her home. There are toys and learning materials present at the facility during today's inspection. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. The licensee has a well in the backyard located in the off limit area.

The home has a fully charged fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificate is expired. The licensee's mandated reporter training is complete and she received a certification of completion on 5/24/25. The licensee is in
(See 809-Cs and 809-Ds for continuance)
NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Briana Plumboy
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2026
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 15
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 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315
VISIT DATE: 06/30/2026
NARRATIVE
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compliance with the immunization law. The home has centralized heating. Per licensee, there are no firearms in the home. The licensee has not conducted or documented a disaster drill since being licensed.
4 Children files were reviewed, The LIC 9040 is not available during today's inspection and was requested by LPA Plumboy at 10:32am. The licensee is not in ratio today and this was observed at 10:23am during LPA Plumboy's tour/inspection with licensee.

Licensee is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing 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) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.



To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record 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.
(See 809-Cs and 809-Ds for continuance)
NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Briana Plumboy
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC809 (FAS) - (06/04)
Page: 3 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 12:10 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above during today's inspection.
At 10:23am, LPA observed 6 infants and 2 preschool age children in care during the inspection of the home.
This requirement was not met as evidenced by the licensee is operating out of ratio which poses an immediate health and safety risk to children in care.
POC Due Date: 07/01/2026
Plan of Correction
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On or before 7/1/26, Licensee must reduce the amount of infants she has in care and maintain the ratio specified on license. LPA to revisit to ensure Licensee is remaining within ratio.
Licensee will also notify LPA Plumboy her plan for maintaining ratio and a schedule consisting of the children's names and which days of the week they will be in care in order for her to come back into compliance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 4 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 12:10 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, observation, and record request, the licensee did not comply with the section cited above due to her not having a disaster drill log and stating she has not conducted a disater drill which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
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Licensee shall conduct a disaster drill and submit a copy of drill log to LPA Plumboy by POC date of 7/14/26.
Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 5 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 12:10 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

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
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4
Based on observation, the licensee did not comply with the section cited above by having objects inside the infant cribs while the infants were asleep which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
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Licensee and LPA Plumboy discussed the importance of having nothing in the play yard/ crib with an infant while they are sleep. Licensee is aware there may be no blankets in the bed while infants are sleep. Licensee will review the safe sleep regulations on the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep and submit a statement after reviewing the regulations to LPA Plumboy once she understands the regulation. Licensee may contact LPA Plumboy for any clarification needed regarding the Safe Sleep Regulations.
Type B
Section Cited
CCR
102425(g)
Infant Safe Sleep
An infant’s head shall not be covered while sleeping.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation at 10:30am, the licensee did not comply with the section cited above due to an infant asleep in a crib with his head covered by a blanket which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
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Licensee and LPA Plumboy discussed the importance of having nothing in the play yard/ crib with an infant while they are sleep. Licensee is aware there may be no blankets in the bed while infants are sleep. Licensee will review the safe sleep regulations on the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep and submit a statement after reviewing the regulations to LPA Plumboy once she understands the regulation. Licensee may contact LPA Plumboy for any clarification needed regarding the Safe Sleep Regulations.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 6 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 12:10 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation and request for record review, the licensee did not comply with the section cited above due to not checking on the napping infants in LPAs presence or having a 15 minute log available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2026
Plan of Correction
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Licensee will begin using these sleep logs on all infants birth to 24 months, monitoring and recording 15 minute checks and keep the records for 3 years. Each Friday beginning 7/3/26 until 7/31/26, licensee will submit her sleep log to LPA Plumboy.
Type B
Section Cited
CCR
102425(j)(5)
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, Upon entrance into the home, LPA Plumboy observed the second room on the left side of the hallway's door closed with 2 infants inside asleep. Licensee opened the door for LPA Plumboy to inspect the room. At 12:05pm, LPA Plumboy observed the door was still closed with 2 children laying down. LPA Plumboy informed Licensee when an infant is asleep, the door must remain open which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
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Licensee and LPA Plumboy discussed the importance of having nothing in the play yard/ crib with an infant while they are sleep. Licensee is aware there may be no blankets in the bed while infants are sleep. Licensee will review the safe sleep regulations on the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep and submit a statement after reviewing the regulations to LPA Plumboy once she understands the regulation. Licensee may contact LPA Plumboy for any clarification needed regarding the Safe Sleep Regulations.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 7 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 12:10 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(b)
Admission Procedures and Authorized Representatives Rights
(b) The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation the licensee did not comply with the section cited above by not posting PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2026
Plan of Correction
1
2
3
4
On or before 7/1/26, Licensee will post PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area. LPA Plumboy Printed a copy of PUB 394 and provided it to licensee.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 6 out of 8 children present during today's inspection do not have immunization records on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
1
2
3
4
On or before 7/14/26 licensee will provide LPA Plumboy with a copy of the five children missing immunization record via email or text. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 8 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 12:10 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on file review, 4 out of 8 children present during today's inspection have LIC 700 on file, and 3 out of 8 files do not have consent for emergency medical treatment which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
1
2
3
4
On or before 7/14/26 licensee will provide LPA Plumboy with a copy of all missing children's files via email. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above by not having LIC 9040 (roster) on file. When asked for the children's roster LIC 9040 during today's inspection, licnesee stated she does not have it which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
On or before 7/3/26, licensee will provide LPA Plumboy with a roster (Lic.9040) containing all information for all children enrolled in her childcare. LPA Plumboy provided a blank LIC 9040 to licensee during today's inspection. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 9 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 12:10 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in 4 out of 8 children in care do not have LIC 995A on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
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2
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4
Based on file review, 4 out of 8 children present during today's inspection do not have LIC 995A on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 10 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 02:37 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
Licnesee's CPR/ First Aid certificate expired on 5/5/26. Based on record review, the licensee did not comply with the section cited above due to her CPR/ First Aid certificate expiring 5/5/26 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2026
Plan of Correction
1
2
3
4
The Licensee will submit proof of enrollment in an approved CPR/First Aid course, to LPA by email, fax or mail by 7/3/26. Licensee will complete CPR/ First Aid training by 7/14/26

The Licensee will submit a copy of the CPR/First Aid certificate upon completion of the class.
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.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 13 of 15
Document Has Been Signed on 06/30/2026 03:47 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/30/2026 at 02:52 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102352(f)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
102352(f)(1) "Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver’s own home, for periods of less than 24 hours per day, while the parents or authorized representatives are away. Based on interview, the licensee did not comply with the section cited above due to her not residing at the licensed childcare facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2026
Plan of Correction
1
2
3
4
Licensee is aware she must reside at the licensed family childcare home. Licensee will submit a piece of mail to LPA Plumboy by 7/1/26 showing she lives in the home. Licensee will submit 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.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 14 of 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WU, CAIQUN
FACILITY NUMBER: 015701315
VISIT DATE: 06/30/2026
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility.

The attached Type A deficiencies are cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file.

A notice of site visit was given and must remain posted for 30 days.



See 809-D for deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee.
NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Briana Plumboy
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC809 (FAS) - (06/04)
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