384004851-3-13-2025-05-CC-MTSO-DER3BW-20250313180702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004851
Report Date: 03/13/2025
Date Signed: 03/13/2025 06:07:20 PM

Document Has Been Signed on 03/13/2025 06:07 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, SAMMI		FACILITY NUMBER:	384004851
ADMINISTRATOR/ DIRECTOR:	SAMMI WU		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 373-7878
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94134
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 5	CENSUS: 4	DATE:	03/13/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:59 PM
MET WITH:	Sammi Wu		TIME VISIT/ INSPECTION COMPLETED:	06:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On March 13, 2025 at approximately 3:00pm, Licensing Program Analyst (LPA) Tso conducted an unannounced required annual visit to the Family Child Care Home listed above. The LPA was granted entry by the Licensee, Sammi Wu. LPA explained the purpose of the visit. Present during LPA's visit included licensee, licensee's spouse, and 4 enrolled children (1 infant and 2 preschool age).Two of licensee's minor children are under the age of 10 years old. Licensee understands children under 10 years old that live in the home are counted towards overall capacity. The licensee is operating within capacity limits and ratio during LPA's visit. The Licensee submitted a statement to LPA during today (3/13/2025) visit to extend the bathroom that next to the in-law dining room as on-limits (daycare) area. Licensee owns and lives with spouse, mother-in law and 3 minor children in these 2 stories 3 bedrooms single family house. All adults living in the home have criminal record clearance on file. The hours of operation are Monday through Friday 8:00am to 6:00pm. DAY CARE AREAS are located on the in-laws with a dining room, a playroom, a sleeping room, and the whole backyard. A deck on the lower level is used as a pathway to the backyard. There was a gate at the stairway. (Daycare children cannot stay there for any activities). OFF LIMIT AREAS are the entire upper level, garage, & a deck on the lower level. Off-limit areas are properly barricaded with child safety gates and/or closed doors. The licensee understands that off-limits areas may not be used for childcare during business hours. (Continued Report on Page 2...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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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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, SAMMI	FACILITY NUMBER: 384004851
	VISIT DATE: 03/13/2025

NARRATIVE

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LPA inspected the indoor and outdoor daycare areas to identify health and safety hazards. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a combination of smoke and carbon monoxide detector (tested under working conditions during the visit , and a 3A40BC fire extinguisher that was available for use. Toys and equipment that were suitable for children of the proper age range are provided at the daycare. The facility has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. According to the licensee, there are reportedly firearms on the premises. The firearm and ammunition were locked separately at the off-limit areas. LPA did not observe any walkers, bouncers, or other comparable objects during today’s inspection. There were no bodies of water observed at the facility.

The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The Licensee is aware that smoking is not permitted in a family childcare facility.

Bathroom for children's use was observed to be in proper working condition. LPA did not observe any hazardous materials to be accessible to children. Entire backyard is fully enclosed and fenced. The outdoor area is equipped with a variety of toys and materials. There is a play structure in the backyard that was observed to be in good condition. Flooring in backyard includes artificial grass that was observed to be clean.
LPA reviewed four children’s records. Children’s files have a record of emergency identification information on file. The immunization records of a child and the15 minutes sleeping check for infant records were not found at the facility (refer to LIC9102). Licensee's Pediatric First Aid/CPR is current and will expire 09/2025. No emergency drill was conducted in the last 6 months (LIC9102). Licensee has licensing documentation properly posted and available for review.

LPA reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training.
(Continued Report on Page 3...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

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, SAMMI	FACILITY NUMBER: 384004851
	VISIT DATE: 03/13/2025

NARRATIVE

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Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622. The immunization records against MMR of the licensee and a helper were not found at the facility (Refer to LIC9102).

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.
(Continued Report on Page 4...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

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, SAMMI	FACILITY NUMBER: 384004851
	VISIT DATE: 03/13/2025

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.

During the exit interview, the licensee, Sammi Wu, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On 03/13/2025, the Bathroom that next to the in-law dining room was added to the on-limit (day care) areas.

The updated Daycare and Off-limits area are as follows.

DAY CARE AREAS are located on the in-laws with a dining room, a playroom, a sleeping room, bathroom, and the whole backyard. A deck on the lower level is used as a pathway to the backyard. There was a gate at the stairway. (Daycare children cannot stay there for any activities).

OFF LIMIT AREAS are the entire upper level, garage, & a deck on the lower level.

There were no deficiencies cited at this time under CCR, Title 22, Div. 12, Chapter 3. A copy of today’s report was given to the licensee.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Sammi Wu.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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