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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002679
Report Date: 09/07/2023
Date Signed: 09/07/2023 12:28:45 PM

Document Has Been Signed on 09/07/2023 12:28 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: 5DATE:
09/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Jack Lee & Wendy MaiTIME COMPLETED:
12:50 PM
NARRATIVE
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On September 7, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted a case management deficiency in conjunction with complaint follow up investigation. LPA met with licensees, Jack Lee & Wendy Mai, and explained the purpose of this report. Present during inspection are both Licensee caring for five children (4 infants and 1 preschooler). All adults present in the home have fingerprint clearance and are associated to the facility.

At approximately 10:30 am, LPA reviewed new children's roster. Previous roster given to LPA during initial complaint investigation was not up to date. LPA called parents and some parents indicated they have not been at the daycare for over a year. LPA requested new roster during today’s visit. Upon reviewing new roster, one child recently turned 2 yrs. old on September 2, 2023. Per Licensee these same children were in the daycare during initial complaint visit. LPA compared rosters and two children’s names were not on original roster LPA originally collected. Upon review and questioning Licensee children were here during initial complaint investigation. LPA determined facility was over capacity with 5 infants in care.

Deficiency cited today under California Code of Regulations, Title 22, Division 12, which follows on LIC 809D.

LPA informed licensees, Jack Lee & Wendy Mai that this report dated September 7, 2023, documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health and safety of children in care.

LPA informed licensee, Jack Lee, and Wendy Mai to provide a copy of this licensing report dated September 7, 2023, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with licensee, Jack Lee & Wendy Mai. A copy of the Appeals Rights was provided. 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.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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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Document Has Been Signed on 09/07/2023 12:28 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 09/07/2023 at 11:51 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: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/07/2023
Section Cited
CCR
102416.5(a)

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102416.5(a): Staffing Ratio and Capacity: The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by:
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Licensee agrees to maintain updated roster and understands that only 4 infants(0-24mths) are allowed to maintain capacity ratios. Child turned 2 yrs old on September 2, 2023. As of today facility is within capacity and POC cleared.
Per Licensee, Jack Lee, all children are fulltime M-F 8:30-5:30 PM.
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Based on observation, interview, record review, the licensee did not comply with the section cited above as there were five infant children in care during initial complaint investigation and outdated children's roster was given to LPA. On August 2, 2023 there were 5 infants and 6 preschoolers present, which poses an immediate health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023


LIC809 (FAS) - (06/04)
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