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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423582
Report Date: 09/10/2021
Date Signed: 09/10/2021 10:08:56 AM

Document Has Been Signed on 09/10/2021 10:08 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:TAM, WING YEE MAEGAN, & CHEN, SHIRLEYFACILITY NUMBER:
013423582
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/10/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Maegan Tam and Shirley ChenTIME COMPLETED:
11:00 AM
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On 09/10/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an announced visit for the purpose of having a conference with the licensee's, per their request. LPA was met by Carol Wong, Maegan Tam, and Shirley Chen. Present for the inspection was one infant and four preschoolers.

The purpose of the conference was to discuss changes to the facility.

The following was discussed:
1. Commingling: LPA reminded the facility that the play yard between both homes (other facility number #013423619) should be used at staggered times between the licenses.
2. Staffing: Maegan Tam, will be removed from the license because she has not lived in the facility since June 2021. LPA reminded facility that the Department must be made aware of any changes. Carol Wong stated they are working on hiring consistent assistants.
3. Safe sleep: LPA discussed safe sleep requirements and infant sleeping plans.

Facility discussed the model of their program and how they plan to run the day care in the upcoming months.

Exit interview conducted, notice of site visit provided, and a copy of this report was left with Shirley Chen.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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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