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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700004
Report Date: 07/14/2021
Date Signed: 07/14/2021 09:53:57 AM

Document Has Been Signed on 07/14/2021 09:53 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:YANG, YANGFACILITY NUMBER:
015700004
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Yang YangTIME COMPLETED:
10:00 AM
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On 7/14/21, Licensing Program Analysts Briana Plumboy met with licensee Yang Yang for an UNANNOUNCED REQUIRED 1 YEAR ANNUAL INSPECTION. Present for the inspection was licensee's preschool age daughter and 1 other child in care. Licensee stated she will only be providing care for one family and would like to be placed on inactive status.

Licensee completed LIC 9211 inactive status request and gave it to LPA. LPA and licensee discussed that licensee could cancel the inactive status by calling or in writing if she wishes to provide child care or she may extend the inactive status in the future.
LPA, advised the Licensee of the conditions of being on Inactive Status. Licensee has agreed to the terms and conditions. LPA presented to the Licensee LIC. 9211 Request for Inactive Child Care License Status. This form was approved by the Licensing Program Analyst.

LPA advised within 10 business day the licensee will be sent a new license which will reflect her inactive status.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2021
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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