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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500731
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:04:39 PM

Document Has Been Signed on 09/19/2024 02:04 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CHEN, YUELINGFACILITY NUMBER:
394500731
ADMINISTRATOR/
DIRECTOR:		CHEN, YUELINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 518-0428
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:37 PM
MET WITH:Yueling Chen TIME VISIT/
INSPECTION COMPLETED:
02:39 PM
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On September 19, 2024, Licensing Program Analyst (LPA) Stacey Williams conducted a case management inspection and met with Yueling Chen. LPA observed (9) nine children in the home being supervised by Licensee and her Assistant.

LPA discussed an incident report that was submitted to Community Care Licensing on August 29, 2024 with Licensee and gathered additional information regarding the incident.

Exit interview conducted and report was reviewed with Licensee, Yueling Chen. A notice of site visit 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: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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