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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421860
Report Date: 02/23/2023
Date Signed: 02/23/2023 11:40:34 AM


Document Has Been Signed on 02/23/2023 11:40 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:YAN, JIEPINGFACILITY NUMBER:
013421860
ADMINISTRATOR:YAN, JIEPINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 387-9063
CITY:SAN LEANDROSTATE: CAZIP CODE:
94579
CAPACITY:14CENSUS: 12DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jieping YanTIME COMPLETED:
11:45 AM
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On February 23rd, 2023 at 9:35AM, Licensing Program Analyst (LPA) April Wright met with licensee Jieping Yan for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during inspection were 12 children and fingerprint cleared assistants Yuzhen Wu and Shaoping Xu. Also present was the Licensee fingerprint cleared spouse Yong Chen. LPA toured the facility to conduct a health and safety inspection. Hours of operation are 8am - 5:30pm Monday through Friday.

The single story home was neat and orderly, with heating and ventilation for safety and comfort of children in care. The isolation area is the dining area which is a section away from other children in care.

On limit areas include: Day care area: living room, dining room, family room, hallway bathroom #1 located between the living and family room, portion of backyard.
Off-limits areas include: Kitchen (walk through only) Master bedroom #1, bathroom #2(inside the master bedroom) bedroom #2 through #4, garage, and portion of the backyard (garden), shed, deck( walk through only).
The off limits are and will be made inaccessible by closed and/or locked doors and visual supervision. There are gates present to prevent access to the off limits areas of the home. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. There are age appropriate toys that appear to be safe and in good condition.

The home has a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detector, fully stock First Aid Kit. and telephone. There is a fireplace in that is sealed and inaccessible to children in care. Per licensee there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. See LIC809 -C for continuance.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YAN, JIEPING
FACILITY NUMBER: 013421860
VISIT DATE: 02/23/2023
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LPA requested and reviewed the files of six (6) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 10/14/2022. The licensee has a current CPR/First aid certificate which expires 10/2024 and Mandated Reporter training which was completed on 2/1/2023. The licensee is in ratio today. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. No IMS provided at this Facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a childcare center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.



There are no deficiencies cited. A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was reviewed with Jieping Yan.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC809 (FAS) - (06/04)
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