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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200775
Report Date: 10/31/2023
Date Signed: 10/31/2023 06:04:17 PM


Document Has Been Signed on 10/31/2023 06:04 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:BLUEGARDEN CAREFACILITY NUMBER:
079200775
ADMINISTRATOR:HUANG, YANLINFACILITY TYPE:
740
ADDRESS:2729 MARSH DRTELEPHONE:
(925) 208-1325
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 2DATE:
10/31/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Yanlin "Cynthia" HuangTIME COMPLETED:
06:15 PM
NARRATIVE
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On 10/31/2023 at 9:25 AM, Licensing Program Analyst (LPA) J. Sampair conducted a Plan of Correction (POC) inspection. Upon entry into the facility, LPA explained the purpose of the visit to Caregivers Carleen Sablan and Carline Skang. Licensee Yanlin "Cynthia" Huang arrived at approximately 10:00 AM.

This visit was prompted by the citations from the 10/17/2023 annual inspection continuation visit. The Licensee had provided documentation of the correction of some of those citations. However, the Licensee had failed to provide documentation to the LPA that all of the citations had been corrected.

During the visit, the LPA verified corrections of 11 out of 19 total citations. For those citations that had not been corrected, the Licensee incurred a total of $5,600 in fines. A civil penalty of $100 per violation per day shall be assessed until the violations are corrected.

Exit interview conducted with Licensee. A copy of the Appeal Rights and this report provided to Licensee via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2023
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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