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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423582
Report Date: 08/09/2021
Date Signed: 08/09/2021 02:53:56 PM

Document Has Been Signed on 08/09/2021 02:53 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, 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: 0CENSUS: 7DATE:
08/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shirely ChenTIME COMPLETED:
03:15 PM
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On 08/09/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an unannounced visit for the purpose of conducting a required inspection. LPA was met by licensee Shirley Chen. Present for the inspection was 2 infants, 4 preschoolers, and the licensees school aged son. The facility is in ratio. LPA toured the home for a health and safety inspection.
There are no bodies of water. Per the licensee there are no firearms in the home. Hazards and cleaning products are inaccessible to children. Bathroom area was found clean and had supplies for children. Facility has a changing table that they use as needed. LPA observed a fully charged 2A10BC fire extinguisher in the kitchen of the home. The home has a working smoke detector. The facility has not conducted a fire drill, LPA reminded facility fire drills must be conducted at minimum, twice a year.
Safety gates were observed throughout the home. Outdoor play area was inspected and the play structure available for children was observed safe.
Facility has a current roster of children in care. LPA obtained a copy of the roster for children in care. CPR and first aid is current for the licensee, expiring 09/2021.

LPA discussed regulations, supervision requirements, and zero tolerance violations with the facility. LPA also reminded facility of the required forms that need to be posted.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.
No deficiencies cited at this visit. Exit interview conducted, appeal rights provided, and a copy of this report was left with the licensee.

A notice of site visit was given and licensee was reminded that it must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2021
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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