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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626922
Report Date: 04/17/2023
Date Signed: 04/17/2023 12:57:32 PM

Document Has Been Signed on 04/17/2023 12:57 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: 6DATE:
04/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Yezina SallewTIME COMPLETED:
12:00 PM
NARRATIVE
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On 4/17/23 at 11:10 AM Licensing program Analyst, (LPA) LPA arrived at the facility and conducted a case Management deficiency. LPA identified herself, showed her badge and was admitted to the home by Licensee Yezina Sallew. Upon arrival LPA Mangina observed at 11:10 AM that there were 4 infants and 2 toddlers in care. The facility was out of ratio. LPA was told that Licensee David Wang was at an appointment and that he left at approximately 11:00 AM. At 11:11 AM LPA observed that child #1 was in a bouncer seat. Licensee David Wang arrived at approximately 12:00 PM. LPA provided Staffing ratios and capacity regulations. LPA once again offered to refer to Technical Support Program and was refused.
See LIC809-D for type A and type B deficiencies cited.

LPA Mangina informed Licensees David Wang and Yezina Sallew that this report dated 4/17/23 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Mangina informed the facility representative to provide a copy of this licensing report dated 4/17/23 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 Licensees David Wang Yezina Sallew. The Licensees were 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: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2023
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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Document Has Been Signed on 04/17/2023 12:57 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 04/17/2023 at 11:29 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: 04/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2023
Section Cited
CCR
102416.5(b)(2)

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STAFFING RATIO AND CAPACITY: 102416.5(b)(2)
For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time… shall be one of the following: Six children, no more than three of whom may be infants;
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Licensees David returned to the facility at 12:00 PM. Licensee states will schedule all appointments after infants leave at 3:00 PM in future and will ensure that when only 1 caregiver present that facility will abide by small family child care license ratios per regulation.
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Based on observation the Licensee failed to comply with the regulation above as she was out of ration, as she alone in the home caring for four infants and two toddlers which poses an immediate health, safety, or personal rights risk to 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: 04/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/17/2023 12:57 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 04/17/2023 at 11:36 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: 04/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2023
Section Cited
CCR
102417(g)(10)

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Operation of a Family Child Care Home. A baby walker/exersaucers/bouncy seat/walkers/jumper are not permitted on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).
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 Licensee removed the bouncy seat immediately and removed it to off limits area and stated that will not use bouncers, walkers or jumpers in the future.
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Based on observation the Licensee failed to comply with the regulation above as child 1 was placed in a bouncer seat, which poses an potential health, safety or personal rights risk to 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: 04/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023


LIC809 (FAS) - (06/04)
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