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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004749
Report Date: 05/15/2026
Date Signed: 05/15/2026 03:37:07 PM

Document Has Been Signed on 05/15/2026 03:37 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: DATE:
05/15/2026
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:03 PM
MET WITH:XiuLing WuTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On May 15, 2026, at 2:00 PM, Licensing Program Manager (LPM) Leung and Licensing Program Analyst (LPA) Van conducted an informal meeting at the San Bruno Regional Office with licensee Xiu Ling Wu. The purpose of the meeting was to review the licensee’s history of non-compliance and to provide clarification and guidance. The discussion included a review of large family child care capacity requirements, prior over-capacity, infant safe sleep regulations, physical plant expectations, and the importance of providing accurate information during inspections in accordance with 1596.855(c).

LPM and LPA reviewed and discussed all prior deficiencies and technical violations.

During the April 23, 2026, inspection, the licensee was cited for the following:

· 102416.5(e) – Staffing Ratio and Capacity: The licensee operated beyond the licensed capacity and limitations by supervising eight children (three infants and five preschool-age children) without an assistant, which exceeded the allowable limits for a large family child care home when support staff is not present.


· 1596.855(c) – Providing Inaccurate Information: The licensee provided inaccurate information regarding the presence of an assistant, hindering the Department’s ability to accurately assess staffing, supervision, and capacity.
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During the May 29, 2024, inspection, the following deficiencies were cited:
· 102416.3(a)(6) – Off-Limits Areas: The licensee utilized the kitchen, an off-limits area, without prior approval.
· 1596.8662(b)(1) – Mandated Reporter Training: The licensee and her helpers had not completed the required Mandated Reporter training.
Continued on page 2.
NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2026
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: 05/15/2026
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page 2.
LPM also reviewed several technical violations observed during inspections, including:
· Accessible cleaning products were observed, which pose potential health and safety risks to children.
· Infant safe sleep concerns were noted, including loose bedding and improperly fitted sheets, which do not comply with safe sleep regulations.
· Backyard maintenance issues were observed, including unsecured water hoses and overgrown grass and weeds.

The licensee was formally reminded of the following requirements by the LPM:
· Compliance with small family child care capacity and limitations when no assistant is present.
· Adhere to infant safe sleep regulations, including the use of tight-fitted sheets and the prohibition of blankets, toys, and other items in cribs.
· Maintaining accurate knowledge of the total number of children present at all times.
· Identifying only individuals who are physically present and actively assisting as assistants during inspections.
· Ensuring honest and accurate communication with the Department at all times.
· Keeping all off-limits areas secured.
· Storing cleaning products and disinfectants in inaccessible locations.
· Maintaining a safe outdoor environment, including securing hoses and trimming overgrown vegetation.
· Completing Mandated Reporter training every two years for all personnel.

· Children must be properly secured in booster chairs using the required safety restraints during all meal and snack times.

· Licensee must ensure that children’s safety-restraint harnesses are fully released before lifting or carrying a child from the booster seat to prevent legs or ankles from becoming caught in the harness.

· Remaining current with and compliant with all Department regulations.



The licensee received the following materials during the meeting: Safe Sleep Regulations, Large License Capacity & Limitations Worksheet, and Operation of a Family Child Care Home Regulations.

The licensee was advised that the Department will conduct additional visits to verify ongoing compliance with all applicable regulations.

An exit interview was conducted, and the report was reviewed with the licensee, Xiu Ling Wu.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
LIC809 (FAS) - (06/04)
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