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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504314
Report Date: 10/17/2023
Date Signed: 10/17/2023 04:20:09 PM

Document Has Been Signed on 10/17/2023 04:20 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WAH MEI SCHOOLFACILITY NUMBER:
380504314
ADMINISTRATOR:LEE, ANGIEFACILITY TYPE:
850
ADDRESS:1400 JUDAH STREETTELEPHONE:
(415) 665-4212
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 44DATE:
10/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sammi LinTIME COMPLETED:
04:30 PM
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On October 17, 2023, at approximately 2:30pm, Licensing Program Analyst (LPA) Ly conducted a Case Management Visit. This facility self reported an incident occurred on 10/02/2023 reporting a child who is allergic to egg but was given noodle that contained eggs. LPA met with Facility's Site Supervisor Sammi Lin. Present during today's visit were 12 staff caring for 44 children. Teacher to children ratio is met on this day.

Per incident report submitted to CCLD, a child is allergic to egg but was given egg noodle during lunch time. Child vomited and showed signs of allergic reaction upon after waking up from nap. Per Site Supervisor, child was fine after vomited but facility still notified the parents of the incident. Per Site Supervisor, child returned to school the following day.

During today's visit, LPA reviewed child's file and confirmed with facility staff that child is still attending the program. LPA interviewed Site Supervisor and Program Operation Manager.

Per Interviews, facility chef bought a case of egg noodle. There were 5 labels on the case. The chef checked one of the labels and saw label stated contains "no egg" but didn't know the case is being used for other egg noodles which also contain egg and the case the chef bought is the noodle that contain eggs which the chef didn't read the other 4 remaining labels.

LPA advised Program Operation Manager to be more cautious in the future. Per Program Operational Manager, he had discussed the seriousness of the incident with the kitchen staff and will be extra cautious with the food they serve. Any new products will need an approval before serving it to children.

No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and left with Site Supervisor whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to Director.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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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