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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626922
Report Date: 03/22/2023
Date Signed: 03/22/2023 10:13:42 AM

Document Has Been Signed on 03/22/2023 10:13 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: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: 6DATE:
03/22/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:David Wang and Yezina SallewTIME COMPLETED:
10:15 AM
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On 3/22/23 at 9:45 AM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction Case Management visit to the child care home to follow-up on deficiencies cited during a Plan of Correction visit on 3/6/23. LPA met with Licensees David Wang and Yezina Sallew. Also, in the home were 6 children in care. Proper ratios and capacity were observed.

During the visit LPA verified that the following were completed:

1) Licensees to complete sleep plan for child 1 (LIC811 dated 2
2) Licensees to conduct fire drill (completed 3/7/23)
3) Licensees to complete Sleep logs for child 1, child 3 and child 6 (LIC811 dated 2/8/23)

No deficiencies cited.

Exit interview conducted and report was reviewed with the licensee, David Wang. Licensees were offered Techniacal Support Program (TSP) brochure and referral. Licensee stated will contact LPA at a later time if they decide to participate. Notice of Site Visit LIC9213 was also provided and must be posted for 30 consecutive 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: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
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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