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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700437
Report Date: 05/20/2024
Date Signed: 05/20/2024 11:37:13 AM

Document Has Been Signed on 05/20/2024 11:37 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SU, YINGFACILITY NUMBER:
015700437
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
05/20/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Ying SuTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 5/20/2024 at 10:20AM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Ying Su for an Unannounced Capacity Increase Inspection. Present for this visit were 5 preschool aged children, Licensee's minor daughter, Licensee's fingerprint clear and associated mother and one adult without a fingerprint clearance. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:30AM until 5:30PM.

ON LIMIT AREAS: Day Care Room, lower level bathroom, lower level bedroom, lower level backyard area.
OFF LIMIT AREAS: Garage, Lower level kitchen, entire second floor and third floor, and upper deck in the backyard.
ISOLATION AREA: lower level bedroom

The home has gained a fire clearance on 5/8/2024 from the Alameda County Fire Department with the condition of the garage not to be used for childcare and the only the first floor can be used.

The facility is a single family three level home. The home is neat and clean with heating and ventilation for safety and comfort. The backyard play area is fenced. There are no pools, hot tubs or any other bodies of water in the on limit areas during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that during the inspection there are no toxins or hazardous items accessible to the children in care. Licensee stated that the adult without a fingerprint clearance is here for a trial and does not know if she is going to work there. LPA informed Licensee that all adults living, working, or volunteering in the home need to have a criminal record clearance prior to being in the home.

Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SU, YING
FACILITY NUMBER: 015700437
VISIT DATE: 05/20/2024
NARRATIVE
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The home has one (1) fully charged 3A40BC fire extinguisher in the family room. There is a working carbon monoxide detector and smoke alarm in the home. The home is equipped with central heat and air for proper ventilation. The fireplace in the day care room is blocked by furniture making it inaccessible to children in care.

Licensee’s Health and Safety training has been completed and Pediatric CPR and First Aid training is complete and expires on 1/2025. Licensee’s Mandated Reporter training is complete and expires 12/17/2024.

There was one deficiency cited on today's visit. See 809-D for deficiency.

This home has been recommended for a capacity increase for a large family childcare home on 5/20/2024.

All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

LPA Jackson informed Licensee that this report dated 5/20/2024 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Jackson informed the Licensee to provide a copy of this licensing report dated 5/20/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Appeal rights provided and discussed.

Exit interview conducted and report was reviewed with Licensee Ying Su.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/20/2024 11:37 AM - It Cannot Be Edited


Created By: Jaleesa Jackson On 05/20/2024 at 10:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SU, YING
FACILITY NUMBER: 015700437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2024
Section Cited
CCR
102370(d)

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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:

This requirement is not met as evidenced by:
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Licensee will either submit proof of a fingerprint clearance completed for A1 or she will write a signed and dated statement understanding that all adults in the home need to have fingerprint clearance prior to working, residing, or volunteering in the home.
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Based on observation, interview, and record review licensee has an unclear adult working in the facility which poses an immediate risk to the health, safety, and personal rights to children 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.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2024


LIC809 (FAS) - (06/04)
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