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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700208
Report Date: 10/03/2022
Date Signed: 10/03/2022 02:48:09 PM

Document Has Been Signed on 10/03/2022 02:48 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:YING, JENNIFERFACILITY NUMBER:
075700208
ADMINISTRATOR:YING, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 456-5339
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
10/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jennifer YingTIME COMPLETED:
02:55 PM
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On October 3, 2022 at 1:50pm, Licensing Program Analyst (LPA) Julia Placencia conducted a case management visit while at the facility for an annual inspection. LPA met with licensee Jennifer Ying. Present were nine children (three infants and six preschoolers) and the licensee's husband Chun "Eric" Lin.

The purpose of today's visit was to follow up on an unusual incident report received in the licensing office on 9/21/22. LPA toured the facility, interviewed licensee and reviewed C1's file.

No deficiencies were cited as a result of today's visit.

Exit interview conducted with Jennifer Ying.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
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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