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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407206
Report Date: 09/06/2019
Date Signed: 09/06/2019 03:16:07 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:PHONGSA, YUNLIFACILITY NUMBER:
073407206
ADMINISTRATOR:PHONGSA, YUNLIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 218-2388
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:14CENSUS: 7DATE:
09/06/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Yunli PhongsaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Julia Placencia arrived unannounced for a case management inspection, and met with licensee Yunli Phongsa. Present were one infant, six preschoolers and the licensee's fingerprint cleared mother.

The purpose of today's inspection is to follow up on a Stop Work Order issued to licensee on 8/27/19 by the City of San Ramon, regarding the use of the licensee's converted garage. It has been determined that the licensee did not obtain proper permits to convert her garage into a child care room. Licensee states she has never used the garage for child care, only for her own family's use. LPA did not observe the garage to be used for day care. The garage is now OFF LIMITS.

LPA advises licensee to submit an updated facility sketch clearly identifying rooms which are OFF LIMITS for day care, which should include said garage. Submit sketch to LPA by 6/13/19.

No deficiencies are cited today. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.

Exit interview with Yunli Phongsa, and copy of report provided.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019
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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