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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004749
Report Date: 04/23/2026
Date Signed: 04/23/2026 04:06:26 PM

Document Has Been Signed on 04/23/2026 04:06 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, XIULINGFACILITY NUMBER:
384004749
ADMINISTRATOR/
DIRECTOR:		WU, XIULINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 324-9002
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
04/23/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:26 PM
MET WITH:XiuLing WuTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On April 23, 2026, Licensing Program Analyst (LPA) Van met with Licensee XiuLing Wu for a case management inspection. The purpose of the inspection was to follow up on an unusual incident self-reported by the licensee. At the time of the inspection, the licensee was supervising eight children (three infants and five preschoolers), which exceeded the capacity permitted under her license when no assistant was present. Without an assistant, the licensee must operate as a small family child care home license, which states a capacity of 6: No more than 3 infants, or up to 4 infants only. Capacity of 8: No more than 2 infants, plus 1 child in kindergarten or elementary school, and 1 child who is at least 6 years old.

When LPA informed the licensee of the over-capacity issue, the licensee stated that her husband was in the backyard. LPA proceeded to the backyard; however, the husband was not present. The licensee then stated that her husband was in the bathroom located in the garage. LPA called out from outside the bathroom but received no response. LPA knocked on the bathroom door, found it unlocked, and opened it; the licensee confirmed that no one was inside. No individuals were present in the garage. During this time, the licensee was on the phone and, at one point, opened the side gate to the backyard and walked outside to the street. LPA instructed the licensee to return to the home, as children were on the second floor without adult supervision.

Approximately 5–7 minutes later, LPA observed the licensee’s husband entering the home through the door leading from the garage stairs.

Continued on page 2.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2026
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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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, XIULING
FACILITY NUMBER: 384004749
VISIT DATE: 04/23/2026
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page 2.
The facility reported an unusual incident on April 10, 2026, involving a child whose leg became caught while climbing in and out of a floor booster chair, resulting in a fractured right ankle confirmed by X-ray. During today’s interview, the licensee stated that the child had finished eating and that the tray had been removed. While the licensee was cleaning near the booster seat, the child climbed onto it, and the licensee heard a “click” before tending to the child. The child did not cry but showed facial discomfort and was unable to bear weight on the right leg. The licensee immediately notified the family of the incident.

LPA reminded the licensee that children must be properly secured in the booster chair with the required safety restraints while eating. LPA also advised the licensee that once a child finishes their meal, the child must be removed from the booster chair, and the tray reinstalled to prevent the child from climbing back into the seat.

Based on LPA observations and interviews regarding the incident, no deficiencies were issued, and no violations were identified at this time.

See LIC 809D for deficiencies issued today for operating over the license limitations.

LPA Van informed the Licensee, XiuLing Wu, that this report, dated April 23, 2026, documents 1 Type A citation(s) which shall be posted for 30 consecutive days, as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Van informed the Director to provide a copy of this licensing report dated April 23, 2026, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgment of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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

An exit interview was conducted, and the report and appeal rights were reviewed with the Licensee, XiuLing Wu.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/23/2026 04:06 PM - It Cannot Be Edited


Created By: Brendon Van On 04/23/2026 at 03:00 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, XIULING
FACILITY NUMBER: 384004749

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/24/2026
Section Cited
CCR
102416.5(e)

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102416.5 Staffing Ratio and Capacity (e) (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement was not met as evidenced by:
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The licensee must review the Staffing Ratio and Capacity regulations and operate strictly within the licensed capacity at all times. When no assistant is present, the licensee must operate at a small license capacity and limitations. The licensee will maintain an accurate headcount throughout the day and will not accept additional children beyond the allowable capacity unless a qualified assistant is physically present.

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Based on observations and interviews, the licensee did not comply with the section cited above. The licensee was operating over the allowed capacity when no assistant was present. At the time of inspection, the licensee was supervising eight children (three infants and five preschool-age children), exceeding the maximum capacity permitted for a large family child care home without an assistant. This posed a potential health and safety risk to children in care.
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The licensee will review and follow the capacity requirements outlined in CCR 102416.5 and submit a written statement to the Department by April 24, 2026, confirming understanding and compliance with staffing ratio and capacity regulations.

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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.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Brendon Van
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/23/2026 04:06 PM - It Cannot Be Edited


Created By: Brendon Van On 04/23/2026 at 03:20 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU, XIULING
FACILITY NUMBER: 384004749

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2026
Section Cited
HSC
1596.855(c)

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1596.855 Denial, suspension or revocation of license, registration, or special permits; grounds (c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state

This requirement was not met as evidenced by:
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The licensee will provide accurate and truthful information to the Department during all inspections and interactions. The licensee will review staffing and supervision requirements to prevent future misrepresentation.
A written statement will be submitted to the Department by April 30, 2026, confirming the licensee’s understanding of the requirement to provide truthful information and acknowledging that false statements may result in further administrative action.
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Based on observations and interviews, the licensee did not comply with the section cited above. During the inspection, the licensee stated that her husband was present and acting as her assistant. LPA attempted to locate the husband in the areas identified by the licensee, but he was not present. Approximately 5–7 minutes later, LPA observed the husband entering the home from the garage stairs. Providing false information to the Department during an inspection interferes with Licensing’s ability to assess staffing, supervision, and capacity, and poses a potential risk to the health and safety of 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.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Brendon Van
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2026


LIC809 (FAS) - (06/04)
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