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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626922
Report Date: 03/08/2023
Date Signed: 03/09/2023 04:21:52 PM

Document Has Been Signed on 03/09/2023 04:21 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:
03/08/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:David Wang and Yezina SallewTIME COMPLETED:
04:00 PM
NARRATIVE
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LPA WAS UNABLE TO LEAVE A REPORT ON 3/6/23 DUE TO SYSTEM ERROR. BELOW IS THE NARRATIVE FOR THAT VISIT.

On 3/6/23 at 9:30 AM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction visit to the child care home to follow-up on deficiency cited during a Required 1 year annual on 2/8/23. LPA met with Licensees David Wang and Yezina Sallew. Also, in the home were 2 children in care. Proper ratios and capacity were observed. Upon arrival LPA observed that child 1 was in a car seat and when asked. Licensee Yezina stated both that child 1 had just arrived at facility before LPA’s arrival and later admitted that child 1 had in fact arrived at 8:00 AM. During file review, Licensee David stated that he thought he threw out the recently completed files of child 2, child 3 and child 4 (see LIC811 dated 3/7/23) "because they are no longer attending and could not find the "old files." Licensees were reminded that child files must be kept for at least 3 years after disenrollment of the child.

During the visit LPA verified that the following were completed:
1) updated roster of children in care
2) signed LIC995A for child 1, child 2, child 3, child 4, child 5 , and child 6 (see LIC811 dated 2/8/23
3) current CPR cards for Licensees
4) latch installed on bathroom cabinet

The following items still need correction:
1) Licensees to complete sleep plan for child 1
2) Licensees to conduct fire drill
3) Licensees to complete Sleep logs for child 1, child 3 and child 6
4) Licensees David and Yezina to complete Mandated reporter training

continued on LIC809 page 2
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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: 03/08/2023
NARRATIVE
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LIC809 page 2

See LIC809-D for Type A and Type B deficiencies cited. Licensees were also issued civil penalties in the amount of $1500.00 for failure to correct deficiencies cited at Required 1 year Annual Inspection on 2/8/23.

LPA Mangina informed licensees, David Wang and Yezina Sallew that this report dated 3/7/23 documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Mangina informed the licensees to provide a copy of this licensing report dated 3/7/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee, David Wang. 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: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 03/09/2023 04:21 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/07/2023 at 03:43 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: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/07/2023
Section Cited
CCR
102425(h)

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OPERATION OF A FAMILY CHILD CARE HOME: Car seats shall only be used for transportation purposes and shall not be used for sleeping.
This requirement was not met as evidenced by:
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Licensees immediately removed child from car seat and stated will not keep children in car seats as a means of supervision and in future and will remove children from car seats at arrival to the facility.
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Based on observation and interview licensee did not comply with the section cited above as child arrived at facility at 8:00 AM asleep in car seat and observed there at 9:30 AM which poses an immediate health, safety, or personal rights risk 6to children in care.
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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: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 03/09/2023 04:21 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/07/2023 at 03:55 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: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2023
Section Cited
CCR
102421

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CHILDREN'S RECORDS: licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d)...for at least three years following termination of service to the child.
This requirement was not met as evidenced by:
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Licensee states will locate missing child files and provide to LPA no later than close of business 3/13/23 and will in future ensure that all child files are kept for at least 3 years after disenrollment.
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Based on record review and interview the licensee did not comply with the section cited above as Licensee unable to find files and thinks may have thrown them out which poses a potential health, safety, or personal rights risk to persons in care.
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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: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 03/09/2023 04:21 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/08/2023 at 07:04 AM
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: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2023
Section Cited
CCR
102425(c)(1)

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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.

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LIcensee states will provide completed Safe Sleep Plan to LPA no later than close of business 3/13/23.
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Based on record review, the licensee did not comply with the section cited above as Child 1 (LIC811 dated 2/8/23) does not have a safe sleep plan which poses a potential health, safety or personal rights risk to persons in care.
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Type B
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Section Cited
CCR102425(j)(1)

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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:
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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 3/13/23.
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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.
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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: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 03/09/2023 04:21 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/08/2023 at 07:09 AM
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: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2023
Section Cited
CCR
102417(g)(9)(A)

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OPERATION OF A FAMILY CHILD CARE HOME: 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:
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LIcensee states will conduct disaster drill and provide proof to LPA no later than close of business 3/13/23.
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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.
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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: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023


LIC809 (FAS) - (06/04)
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