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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002679
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:10:30 PM

Document Has Been Signed on 09/20/2023 12:10 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:MAI, WENDY C. & LEE, JACK C.FACILITY NUMBER:
414002679
ADMINISTRATOR:MAI, WENDY C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 577-8880
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
09/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Wendy Mai & Jack LeeTIME COMPLETED:
12:25 PM
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On September 20, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon, conducted an unannounced, plan of correction (POC) visit. LPA met with Licensees, Wendy Mai & Jack Lee, and explained the purpose of the visit. Present during LPA visit were both Licensees and 6 children (4 infants and 2 preschoolers).

On September 7, 2023, LPA Maria Olguin-Leon met with licensee to conduct a case management deficiency in conjunction with delivering complaint findings. During visit, LPA determined facility had been operating over capacity with 5 infants and 6 preschoolers during initial complaint visit on August 2, 2023. LPA was given an outdated roster during initial complaint investigation, and it was later determined facility was operating overcapacity during the August 2, 2023 visit. LPA issued a Type A citation for operating over licensed capacity limits. A POC was developed with licensee.

As of this date, LPA Olguin-Leon confirmed the licensee to have only four infants enrolled. Fifth infant turned 2 yrs. old on September 2, 2023. LPA observed licensee to be operating within licensed capacity limits on this date.

During today's visit, LPA observed signed and completed Acknowledgement of Receipt of Licensing Reports (LIC9224) for 6 children. LPA observed facility site visit and reports posted.

Deficiency cited on September 7, 2023, has been cleared as of this date. LPA provided licensee copy of POC letter. No deficiencies were cited today.

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 and cleared POC was reviewed with licensee, Wendy Mai & Jack Lee.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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