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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700241
Report Date: 04/07/2022
Date Signed: 04/07/2022 12:17:43 PM


Document Has Been Signed on 04/07/2022 12:17 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:TSURUTA, YUKIKOFACILITY NUMBER:
015700241
ADMINISTRATOR:TSURUTA, YUKIKOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 598-7058
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:14CENSUS: 10DATE:
04/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yukiko TsurutaTIME COMPLETED:
12:30 PM
NARRATIVE
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On 04/07/2022 Licensing Program Analysts (LPAs) Jaylena Miller and April Wright conducted a subsequent case management inspection as a result of a complaint investigation. LPAs met with Licensee Yukiko Tsuruta. Present for the inspection were 2 staff members, 9 infants and 1 preschooler. Per California Code of Regulations Title 22, Division 12 Chapter 1 Article 06 section 102416.5(d)(2)(b) Staffing Ratio and Capacity compliance was not met. As a result, a Type A deficiency is being cited today.

The licensee must post this report for thirty days. The licensee must give each parent of the children in care and future parents of newly enrolled children, for the next one year following today’s date, a copy of this report. Parents are to sign an LIC 9224- Acknowledgment of Receipt of Licensing reports and this form shall be placed in each child’s file. Failure to post report and or provide a copy of this report to parent’s/authorized guardians can result in additional monetary assessments to the facility. This report must remain on file for three years. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was provided and must be posted for thirty days. Exit interview conducted with licensee, Yukiko Tsuruta.

Please see LIC 9099-D for deficiency cited

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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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Document Has Been Signed on 04/07/2022 12:17 PM - It Cannot Be Edited

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: TSURUTA, YUKIKO
FACILITY NUMBER: 015700241

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/07/2022
Section Cited

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102416.5(d)(2)(b) Staffing Ratio and Capacity
For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time... (2) More than twelve... (b) No more than three infants are cared for during any time when more than 12 children are being cared for. This requirement was not met as evidence by:
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Based on physical plant inspection licensee did not ensure proper ratio capacity when licensee accepted 9 infants into care which poses an immediate risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected. A Non-Compliance Conference will be scheduled at a later date.

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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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