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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621189
Report Date: 06/26/2023
Date Signed: 06/26/2023 07:12:05 PM

Document Has Been Signed on 06/26/2023 07:12 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:FU, YALIFACILITY NUMBER:
343621189
ADMINISTRATOR:YALI FUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 893-3063
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
06/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Yali FuTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Corina Beckby met with Licensee, Yali Fu on 06/26/2023 for the purpose of an unannounced plan of correction inspection to clear multiple Type B deficiencies, which were issued on 05/24/2023.

LPA observed Licensee and cleared assistant caring for 10 preschool children including 1 toddler during today's inspection. LPA toured the facility and found no deficiencies.



LPA observed Licensee’s CPR & First Aid certificate which expires 06/14/2025. This clears one Type B deficiency.

LPA observed Parents Rights poster on parent board. This clears one Type B deficiency.

LPA observed and verified Assistants (Jie Mou) immunization of MMR, Pertussis, TB test. Assistant has a letter of declination for the flu on file at the facility. Assistant had Employee Rights and Statement Acknowledging Requirement to Report Child Abuse forms signed. Mandarin is her primary language; therefore, Mandated Reporter Certificate is not required. These observations clear 2 Type B deficiencies.

LPA observed current Fire Drill log. Last drill was conducted on 06/12/2023. This clears one Type B deficiency.

LPA observed gate at the bottom of stairs closed and in its locked position. This clears one type B deficiency.
CONTINUED ON LIC809 C...
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: FU, YALI
FACILITY NUMBER: 343621189
VISIT DATE: 06/26/2023
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LPA observed the Emergency Disaster Plan posted. This clears one Type B deficiency.


LPA observed a current roster and verified 9 of 10 children’s immunization's were in their files. This deficiency is not cleared. Licensee will remind parents to return all documents and immunization's by 06/28/2023.

7 out of 8 Deficiencies cited on 05/24/2023 are cleared effective today. Proof of correction letters was provided for the 7 corrected deficiencies. LPA reviewed report with Licensee, Yali Fu. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
LIC809 (FAS) - (06/04)
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