384004749-5-20-2026-05-CC-BVAN-DUA27Z-20260520170935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004749
Report Date: 05/20/2026
Date Signed: 05/20/2026 05:09:41 PM

Document Has Been Signed on 05/20/2026 05:09 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, XIULING		FACILITY NUMBER:	384004749
ADMINISTRATOR/ DIRECTOR:	WU, XIULING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 324-9002
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 15	CENSUS: 10	DATE:	05/20/2026
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:51 PM
MET WITH:	XiuLing Wu		TIME VISIT/ INSPECTION COMPLETED:	05:15 PM

NARRATIVE

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On May 20, 2026, Licensing Program Analyst (LPA) Van arrived at the family child care home to conduct an unannounced Plan of Correction inspection. LPA met with Licensee XiuLing Wu, explained the purpose of the visit, and was granted access to the home. Upon entering the home, LPA observed that the children were ready for afternoon snacks. LPA observed that the licensee and an assistant were supervising 10 children (4 infants and 6 preschool-aged). The licensee complied with her licensed capacity and limitations today.

During the annual inspection on April 23, 2026, the licensee was cited for two violations. A Type A violation was issued for being out of compliance with the capacity ratio, as the licensee was supervising 8 children without an assistant, exceeding the limits for a large-family child care home. A Type B violation was issued for providing false information to Licensing. The licensee stated an assistant was present, but LPA was unable to locate the assistant in any of the identified areas provided by the licensee.

In today’s visit, LPA confirmed through observation and records submitted by the licensee that all previously cited deficiencies have been corrected. A qualified assistant is now present when required, and the licensee has implemented procedures to ensure compliance with capacity and staffing regulations. The LPA observed that staffing and supervision were in compliance during the inspection.

During the visit, LPA reminded the licensee of the requirement to maintain accurate knowledge of the total number of children present at all times, as discussed during the Informal Office visit on May 15, 2026. This reminder was issued because the licensee reported that nine children were present, whereas ten children were observed in care during today’s inspection.

Based on today’s inspection, LPAs determined that all deficiencies cited on April 23, 2026, have been corrected, and the facility is now in compliance.

A Notice of Site Visit was issued and must remain posted for 30 consecutive days.

An exit interview was conducted, and the report was reviewed with Licensee XiuLing Wu. The licensee was provided with a copy of this report.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026

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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