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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621189
Report Date: 06/07/2023
Date Signed: 06/07/2023 01:48:38 PM


Document Has Been Signed on 06/07/2023 01:48 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:FU, YALIFACILITY NUMBER:
343621189
ADMINISTRATOR:YALI FUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 893-3063
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:14CENSUS: 12DATE:
06/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Yali FuTIME COMPLETED:
01:30 PM
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On June 7, 2023, Licensing Program Analysts (LPA) Corina Beckby conducted a Plan of Correction Inspection. LPA met with Licensee, Yali,Fu.

Upon arrival LPA observed 12 napping children supervised by Licensee and cleared adult. Licensee is now supervising children within a large capacity family child care home. LPA notified Licensee that all the individuals who were not cleared are now cleared via Guardian. LPA emailed a copy of cleared individuals to Licensee.

Facility evaluation report was reviewed and discussed with Licensee, Yali Fu. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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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