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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101334
Report Date: 05/22/2024
Date Signed: 05/22/2024 03:27:12 PM

Document Has Been Signed on 05/22/2024 03:27 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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:NISHI, YASUYO FAMILY CHILD CAREFACILITY NUMBER:
376101334
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
05/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Yasuyo NishiTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On May 22, 2024 at 1:55 PM. Licensing Program Analyst (LPA), Sherlynn Banas conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Yasuyo Nishi and granted entry after identifying herself and disclosing the purpose of her visit. The licensee is using the Day-care Area, backyard, and the bathroom downstairs as accessible to the children. Off limit areas include living room, kitchen, and dining room. the bedroom downstairs, and all the rooms upstairs. Upstairs was barricaded by a safety mesh gate. Business Hours are 8:30 AM. to 5:00 PM, 3 day/week (Monday, Wednesday and Friday). The facility currently has 5 preschool children. Licensee provided a copy of their current roster and is operating within the licensed ratio and capacity.

The fire extinguisher (located by the Day-care Area), the carbon monoxide (located by the kitchen area), and the smoke detector (located at the hallway by the bathroom) were all operational. Licensee does not maintain any weapons or ammunition in the home.

There are no open face heaters/fireplaces. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Storage for poisons, detergents, medications are stored securely and inaccessible. Outdoor play area is fenced. The last disaster/fire drill was conducted on April 22, 2024. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials. The licensee takes the children to the Crest view Park for outdoor activities beside using the backyard.

Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights.
Pediatric CPR and First Aid cards are current and will expire on September 2024. The Mandated Child Abuse Reporting will expire on September 13, 2024. Staff immunization were reviewed and are in compliance. There is a working telephone and email address.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: NISHI, YASUYO FAMILY CHILD CARE
FACILITY NUMBER: 376101334
VISIT DATE: 05/22/2024
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Safe Sleep

LPA discussed the safe sleep regulations with Licensee, XXX and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Criminal Record Clearance
Licensee, Yasuyo Nishi was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in health and Safety code section 1596.871, must obtain criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

No IMS

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: NISHI, YASUYO FAMILY CHILD CARE
FACILITY NUMBER: 376101334
VISIT DATE: 05/22/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today’s visit, no deficiencies were observed at this time. Exit interview conducted Appeal Rights and report was reviewed with Licensee, Yasuyo Nishi.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC809 (FAS) - (06/04)
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