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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101334
Report Date: 01/19/2023
Date Signed: 01/19/2023 08:08:40 AM

Document Has Been Signed on 01/19/2023 08:08 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:NISHI, YASUYO FAMILY CHILD CAREFACILITY NUMBER:
376101334
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Yasuyo NishiTIME COMPLETED:
08:15 AM
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On 1/18/2023 @ 7:50AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an announced follow-up prelicensing inspection with applicant, Yasuyo Nishi. LPA toured the house with the applicant. The purpose of this follow-up inspection is to observe corrections as requested during the initial inspection on 1/05/2023.

The following corrections were observed/provided today:
1. Applicant submitted a sketch of the second floor of the home. It is being noted that the second floor of the home is off-limits to day care children.
2. The barricade between the kitchen and hallway was observed to be installed appropriately.
3. The plants with thorns was removed from the backyard.

A license for a small family child care is issued effective today, 1/18/2023.

The maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.
Capacity shall include children under age 10 who reside at the licensee’s home.

Exit interview was conducted with Mrs. Nishi. A copy of this report was provided.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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