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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002679
Report Date: 04/24/2025
Date Signed: 04/24/2025 10:54:44 AM

Document Has Been Signed on 04/24/2025 10:54 AM - 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/
DIRECTOR:		MAI, WENDY C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 577-8880
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
04/24/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:Jack Lee and Wendy Mai TIME VISIT/
INSPECTION COMPLETED:
11:05 AM
NARRATIVE
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On April 24, 2025, Licensing Program Analyst (LPA) Leong conducted an unannounced case management visit regarding the facility’s request to add a bedroom to the daycare, which was made on April 21, 2025. LPA met with the Licensees, Jack Lee (S1) and Wendy Mai (S2), and explained the purpose of the visit.

Seven children (four infants and three pre-k), S1 and S2, were present at today’s visit.

LPA inspected Bedroom # 1 to identify potential health and safety hazards. According to S1 and S2, Bedroom # 1 will primarily serve as an area for children to nap. The space is clean and has good ventilation. The electrical outlets were observed to be covered. Playpens are available for children to take naps in. A combo carbon monoxide/smoke detector was observed in the room. An air purifier was also observed in the room and was found to be functioning. A bathroom was in Bedroom # 1, and all cabinets inside were observed locked. The bathroom inside Bedroom #1 will be off-limits.

LPA also inspected the Sun Room and found the floor covered with rubberized mats. Two doors leading to the storage room were equipped with child safety door knob covers. The Sun Room is clean and has good ventilation.

LPA will approve Bedroom #1 and the Sun Room as part of the daycare, effective April 24, 2025.

The new daycare areas on the lower level will consist of Bedroom # 1, the Sun Room, the Living Room, the Dining Room, and the Backyard.

LPA reviewed the Pediatric CPR and First Aid certifications of S1 and S2 and found that they were not issued by the Emergency Medical Services Authority (EMSA), the American Red Cross, or the American Heart Association. Instead, they were from the National CPR Foundation, which is not an EMSA provider.

Please refer to LIC 809D for today’s deficiency.

Appeal rights were given to the Licensee, Jack Lee.

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

Exit interview conducted and report was reviewed with the Licensee, Jack Lee.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2025
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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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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Document Has Been Signed on 04/24/2025 10:54 AM - It Cannot Be Edited


Created By: Hanson Leong On 04/24/2025 at 10:07 AM
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: MAI, WENDY C. & LEE, JACK C.
FACILITY NUMBER: 414002679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2025
Section Cited
HSC
1596.866(d)(1)

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1596.866 Additional health and safety training; condition of licensure
(d) Completion of the training required pursuant to subdivisions (a) and (b) shall be...

This requirement is not met as evidenced by:
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LPA observed S1 and S2 booking the Pediatric CPR and First Aid course from the American Heart Association website. S1 and S2 said they will submit them to the department before 5/24/2025.
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Based on interview and record review, the two licensees did not comply with the section cited above. The two licensee's pediatric CPR and First Aid certifications were not from an EMSA provider, American Red Cross, or American Heart Association...
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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:
Hanson Leong
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2025


LIC809 (FAS) - (06/04)
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