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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422897
Report Date: 01/18/2022
Date Signed: 01/18/2022 03:32:06 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:YUAN, ALICEFACILITY NUMBER:
013422897
ADMINISTRATOR:YUAN, ALICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 754-8253
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 9DATE:
01/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:11 PM
MET WITH:Alice YuanTIME COMPLETED:
03:40 PM
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On 1/18/22 at 3:11pm, Licensing Program Analyst (LPA) Briana Plumboy met with licensee Alice Yuan for an UNANNOUNCED CASE MANAGEMENT INSPECTION. Present for this inspection is licensees fingerprint clear and associated husband Ronald Boivin and 9 children in care. LPA B. Plumboy toured the facility and conducted a physical census of the children in care.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
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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