013421860-9-15-2020-52-CC-BPLY-BTGQRR-20200915122423

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421860
Report Date: 09/15/2020
Date Signed: 09/15/2020 12:24:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	YAN, JIEPING		FACILITY NUMBER:	013421860
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	09/15/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Jieping Yan		TIME COMPLETED:	12:45 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 09/15/20 at 11:45am, Licensing Program Analysts (LPAs) Briana Plumboy and Jabari Wilson conducted an unannounced Case Management Inspection with Licensee Jie Ping Yan. Present for the inspection was licensee's fingerprint clear inlaws Tony Chen and Xuexhen Huang, licensees fingerprint clear and associated husband Yong Chen, and licensees 2 children (1 school age and 1 preschool age). The home was virtually toured by LPA Wilson with the licensee and her husband to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:30am until 6:00pm, and occasional weekends. ON LIMITS: living room, family room, hallway bathroom located between the living and family room, OFF LIMITS: Kitchen/dining room, Master bedroom/master bathroom, 3 bedrooms, garage, and parts of the backyard The home is one level, which consists of 4 bedrooms, 2 bathrooms, living room, dining room, family room, and kitchen. The isolation area will be an area located inside the living room. There is a 3A40BC fire extinguisher, carbon monoxide detector, pull down fire alarm, and smoke detector which meet State Fire Marshall standards during today's inspection. Per licensee, there are no firearms in the home. There are no pets in the home. All required licensing documents are posted and visible for public review. The licensee's Pediatric CPR/First Aid certificate is current and expires 09/12/22. Licensee's mandated reporter training was completed on 03/03/20. Licensee is in compliance with the immunization law. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: YAN, JIEPING	FACILITY NUMBER: 013421860
	VISIT DATE: 09/15/2020

NARRATIVE

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On 08/20/20, a fire clearance was granted to facility #013421860 by Alameda County Fire Department. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .

As of 09/15/20, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. This entire report has been read to the Licensee by LPA Wilson. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Wilson or CCLD. An exit interview was conducted, and appeal rights provided.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

LIC809 (FAS) - (06/04)

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