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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416072
Report Date: 08/15/2019
Date Signed: 08/15/2019 10:49:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LIANG, YAN YINGFACILITY NUMBER:
434416072
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
08/15/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Yan Yin LiangTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced Plan of Correction (POC) to the Facility today. LPA met with Licensee, Yan Ying Liang, and explained the nature of today's visit to her. LPA also observed an assistant and three infants and two preschool children.

The Facility was issued a "Type A" deficiencies on Friday, August 2nd, 2019 for operating over Staffing Ratio and Capacity during an unannounced annual/random inspection on the same day. The Plan of Correction was due on Monday August 5th, 2018.

LPA observed the notice of site visit which was issued on 08/02/2019 was posted on the facility entrance door along with the Type "A" deficiency report. LPA also observed Acknowledge of Receipt of Licensing Report were obtained from parents/guardians of children in care with signature and kept in each child's file.

Licensee obtained a plan of correction statement prior to today's inspection along with an updated and a copy of the complete current roster. LPA concludes that Licensee has completed her required plan of correction and the deficiency is thus cleared as of today's visit.

No deficiency was cited. Exit interview conducted with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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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