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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423610
Report Date: 06/27/2022
Date Signed: 06/27/2022 10:59:58 AM

Document Has Been Signed on 06/27/2022 10:59 AM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:YANG, YAQINFACILITY NUMBER:
013423610
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Yaqin YangTIME COMPLETED:
11:05 AM
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On June 27, 2022 Licensing Program Analyst (LPA) Indira Loza arrived at the facility to conduct an announced Case Management visit for an Increase Capacity. LPA met with Licensee Yaqin Yang. Present for the inspection were the Licensee, Licensee's Assistant and four Preschool-Age children.

The home is a two story home. The home consists of two downstairs bedrooms, one upstairs bedroom, living room, dinning room which is the napping room, kitchen, one bathroom, fenced front yard, fenced back yard and fenced side yard. The fenced front yard will be used for the outdoor play space. Off-Limit Areas are the upstairs bedroom, kitchen, fenced back yard, and fenced side yard. There is a fully charged 2A10BC fire extinguisher, a working smoke detector, a working carbon monoxide detector, and a pull down alarm system.

The facility has been approved for a capacity Increase effective June 27, 2022.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2022
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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