073407192-11-21-2019-02-CC-MGUT-BJ5NL4-20191121093256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407192
Report Date: 11/21/2019
Date Signed: 11/21/2019 09:33:07 AM

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	YANGCHEN, TSERING		FACILITY NUMBER:	073407192
ADMINISTRATOR:	YANGCHEN, TSERING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 610-1711
CITY:	EL CERRITO	STATE: CA	ZIP CODE:	94530
CAPACITY:	14	CENSUS: 3	DATE:	11/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Tsering Yangchen		TIME COMPLETED:	10:00 AM

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 11/21/19, Licensing Program Analyst (LPA), Melissa Guirit, met with licensee Tsering Yangchen for an UNANNOUNCED RANDOM INSPECTION. Present for this inspection were licensee, 2 preschoolers and 1 infant. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are from 7:30 AM to 6:00 PM. The home is one story. The home consists of 2 bedrooms, 2 bathrooms, living room, kitchen, play room, garage, and backyard. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are now the back play room, bathroom closest to the play room, and back yard. The OFF LIMIT AREAS are the 2 bedrooms, one bathroom, living room, kitchen, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be in the corner of the play room. The outdoor play area is free from defects or dangerous conditions and is completely fenced with 100% supervision. There is also a shed on the right side of the back yard that is made inaccessible to children. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. The home has a fully charged 3A40BC fire extinguisher, working combination smoke and carbon monoxide detector, working telephone, and fully stock First Aid Kit. The licensee CPR and First Aid certificate is current and expires 02/2020. Licensee completed the Mandated Reporter Training which expires on 10/27/2020. The licensee is in compliance with the new immunization law. The wall heater is located in the playroom and is screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one on 10/2019. (3) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: YANGCHEN, TSERING	FACILITY NUMBER: 073407192
	VISIT DATE: 11/21/2019

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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 .http://www.myccl.gov/

Incidental Medical Services (IMS) policy was discussed.

There are no deficiencies cited today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and appeal rights provided.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

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