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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626922
Report Date: 02/08/2023
Date Signed: 02/08/2023 02:18:55 PM

Document Has Been Signed on 02/08/2023 02:18 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CAREFACILITY NUMBER:
376626922
ADMINISTRATOR:DAVID WANG & YEZINA SALLEWFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 228-7076
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:David Wand and Yezina SallewTIME COMPLETED:
02:45 PM
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On 2/8/23 at 10:15 AM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Annual inspection with the Licensees. Upon arrival, LPA met with Licensees David Wang and Yezina Sallew. The one-story four bedroom two bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Also present in the home were five day care children. Two additional children arrived at 12:45 PM and 1:00 PM. Proper supervision and ratios were observed. The 2A10BC fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. There are no bodies of water on the property. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a 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 to $500.00 maximum per day/per person will be assessed if this regulation is violated.

At 10:30 AM LPA observed alcohol on accessible living room floor, medications in accessible dining room cabinet, chemicals on bathroom floor, which were removed immediately and hazards under bathroom sink. 11:05 AM LPA observed a walker and a baby bouncer in accessible bedroom. Licensee reminded that baby bouncers seats and walkers may not be used in daycare. 11:10 AM Licensee stated does not keep safe sleep logs. 11:15 AM Licensee states has not had a disaster drill since licensure in 2017. 11:40 AM During file review Licensees stated do not have current Mandated reporter training certificates. 11:45 AM Licensees were not able to provide CPR training certificates. 11:55 AM during file review LPA observed that Licensees do not have current roster of children. 12:00 PM LPA observed that there is no safe sleep plan for child 1 and no sleep logs for child 1, child 3 and child 6. 12:30 PM LPA observed that six of six child files review are not complete.

continued on LIC809 page 2
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CARE
FACILITY NUMBER: 376626922
VISIT DATE: 02/08/2023
NARRATIVE
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LIC809 page 2

Licensee was reminded to ensure that crib and pack and plays may not have loose articles when children are sleeping. Licensee temporarily using playground and walks for outdoor activities as there is a leak in the wall that Licensees are currently having repaired and there are unsafe items in back yard. Licensees reminded to ensure that immunization record is located in personnel files. Licensee reminded to contact Licensing 10 days before undertaking any construction or renovation projects.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include: patio, bathroom, living room and bedroom 4. Off limits areas include: bedroom 1, bedroom 2, bedroom 3, master bathroom and attached garage and are inaccessible through use of locks, safety gates and door knob covers. There is a working phone at the facility. The licensee has sufficient age appropriate, safe, toys and equipment available. The home has a fully fenced backyard available for outdoor activities.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances associated to the facility, corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Mangina reviewed Covid-19 guidelines directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding

continued on LIC809 page

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CARE
FACILITY NUMBER: 376626922
VISIT DATE: 02/08/2023
NARRATIVE
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LIC809 page 3

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.

LPA discussed the safe sleep regulations with licensees 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.



To improve the quality and value of the new inspection process, a survey will 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/process.

See LIC809-Ds for Type B deficiencies cited and LIC9102s for Technical vVolations given.

Exit interview conducted and report was reviewed with the licensees David Wang.and Yezina Sallew. The Licensee was provided a copy of this report. A Notice of Site Visit (LIC9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
Page: 7 of 11
Document Has Been Signed on 02/08/2023 02:18 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/08/2023 at 01:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CARE
FACILITY NUMBER: 376626922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above as there was alcohol on accessible living room floor, medications in accessible dining room cabinet, chemical on bathroom floor, which were removed immediately and hazards under bathroom sink which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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Licensee will install a latch on bathroom cabinet and provide proof to LPA no later than close of business 3/1/23.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview the licensee did not comply with the section cited above as Licensee has not conducted a disater drill since licensure in 2017 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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LIcensee states will conduct disaster drill and provide proof to LPA no later than close of business 3/1/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Askew
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023


LIC809 (FAS) - (06/04)
Page: 11 of 11
Document Has Been Signed on 02/08/2023 02:18 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/08/2023 at 01:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CARE
FACILITY NUMBER: 376626922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as Licensees state do not complete Safe sleep logs as required which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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LIcensee states will complete safe sleep logs for all children under two years old and will provide sleep logs for all infants in care to LPA no later than close of business 3/1/23.

Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as Licensees do not have current mandated reporter training certificates which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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LIcensees will complete Mandated reporter training and provide proof to LPA no later than close of business 3/1/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Askew
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023


LIC809 (FAS) - (06/04)
Page: 3 of 11
Document Has Been Signed on 02/08/2023 02:18 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/08/2023 at 01:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CARE
FACILITY NUMBER: 376626922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as LIcensee could not provide current CPR cards which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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LIcensees will provide current CPR card to LPA no later than close of business 3/1/23.

Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as six of six children in care do not have signed LIC995A which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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LIcensee will ensure to use the proper Parent's rights forms for Family Child care home and will provide signed copies for all children in care to LPA no later than close of business 3/1/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Askew
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023


LIC809 (FAS) - (06/04)
Page: 9 of 11
Document Has Been Signed on 02/08/2023 02:18 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/08/2023 at 01:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CARE
FACILITY NUMBER: 376626922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above as Licensees do not have a roster of children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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2
3
4
LIcensee states will provide a current roster of children to LPA no later than close of business 3/1/23.
Type B
Section Cited
CCR
102425(c)(1)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This plan shall be signed and dated by the infant’s authorized representative.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above as Child 1 does not have a safe sleep plan which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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2
3
4
LIcensee states will provide completed Safe Sleep Plan to LPA no later than close of business 3/1/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Askew
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023


LIC809 (FAS) - (06/04)
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