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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003081
Report Date: 03/21/2025
Date Signed: 03/21/2025 04:05:30 PM

Document Has Been Signed on 03/21/2025 04:05 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:YANG, JIA LINGFACILITY NUMBER:
414003081
ADMINISTRATOR/
DIRECTOR:		YANG, JIA LINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 260-1252
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/21/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:18 PM
MET WITH:Jia Ling YangTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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On 3/21/2025, at approximately 1:25PM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced Plan of Correction (POC) visit at the facility. LPA met with Jia Ling Yang(L1), and explained purpose of the visit. Present during the visit was Licensee and two assistant supervising 11 children. The facility is operating within staffing and ratio requirements on this day.

During the Annual inspection visit on 2/21/2025, (L1) received four Type B citation’s regarding Infant Safe sleep, Administration of Child Care Licensing and Operation of A Family Child Care Home. Which poses a potential health, safety, or personal rights risk to persons in care. A plan of correction was discussed with the licensee. On 3/5/2025 (L1) submitted via email documentation of the 15 minute sleep Logs, Updated renewed Mandated Reporter Training Expiring 2/2027, and a Facility Roster. During LPA’s inspection the Licensee was also able to provide proof of the documented Infant Safe sleep, who keeps track of the infant 15 Minute Sleep check chart via computer.

During today's inspection, LPA observed at approximately 1:28PM two children napping in a crib with blankets. Licensee was able to provide documentation that the children in the crib are over 24months. LPA, also observed The facility had posted the Notice of Site Visit with the required postings in the entrance of the facility.

As of today 3/21/2025 four out of the four citations will be cleared. Deficiencies cited on 2/21/2025, were cleared today. The Letter of Deficiency Citation Cleared were provided to the Licensee.

At approximately 2:10PM LPA Alvarado during record observation, record review and interview was able to confirm that one of the assistants does not have fingerprint clearance. (L1) was able to provide documentation of the Request for Livescan form, the application did not state for Child Care but had “Adult Day Care Facility”.

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Ali ZebilaTELEPHONE: (650) 730-4140
Diana AlvaradoTELEPHONE: 650-266-8800
DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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 03/21/2025 04:05 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: YANG, JIA LING
FACILITY NUMBER: 414003081

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
03/24/2025
Section Cited
CCR
102370(d)(1)

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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
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Licensee was able to provide documentation of the Request for Livescan service process. Licensee will have the staff assistant go back to get the Livescan updated or have fingerprints retaken.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in having an uncleared individual directly working with and supervising enrolled children, which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Ali ZebilaTELEPHONE: (650) 730-4140
Diana AlvaradoTELEPHONE: 650-266-8800

DATE: 03/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YANG, JIA LING
FACILITY NUMBER: 414003081
VISIT DATE: 03/21/2025
NARRATIVE
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 ***THIS IS AN AMENDED REPORT FROM ORIGINAL REPORT DATED 03/21/2025***

LPA informed (L1) that it needs to be re-done and ensuring it states child care. (L1) was informed that for the assistant, fingerprints will need to be updated or re-taken again. (L1) stepped out of the facility at 2:55 to pick up her child from school and returned at approximately 3:12PM.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Jia Ling Yang

Appeal rights were provided to Licensee, Jia Ling Yang.
SUPERVISOR'S NAME: Carol MarcroftTELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
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