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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004502
Report Date: 12/06/2022
Date Signed: 12/06/2022 10:21:25 AM

Document Has Been Signed on 12/06/2022 10:21 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:XIAO, YANGFACILITY NUMBER:
414004502
ADMINISTRATOR:XIAO, YANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 544-8111
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
12/06/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yang "CoCo" XiaoTIME COMPLETED:
10:15 AM
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The following meeting was conducted virtually via Microsoft Teams.

On December 6, 2022 at approximately 9:30am, Licensing Program Manager (LPM), Cindy Interiano, Licensing Program Analysts (LPAs), Catrina Quimbo and Maria Olguin-Leon, conducted a virtual, office meeting with licensee, Yang “CoCo” Xiao, via Microsoft Teams. The purpose of the informal meeting was to discuss repeat violations of licensee operating over capacity and un-fingerprinted adults working in the facility.

Repeat violations discussed during this meeting included:
• Staffing ratio and Capacity. Licensee was cited 06/01/2022, 09/27/2022, and 10/11/2022 for operating over licensed capacity limits. During LPA’s visits on 09/27/2022 and 10/11/2022, licensee was found to be operating with 10 enrolled children, 8 infants and 2 preschool age.
• Criminal Record Clearance. Licensee was cited 04/06/2022 and 09/27/2022 for unfingerprinted adults. During LPA’s visits, LPA observed uncleared adults to be directly working with and supervising enrolled children.

Licensee was reminded:
• Capacity limits and requirements for a small and large licensed capacity was explained. Capacity worksheets have been provided to licensee during LPA’s past visits.
• Licensee’s children, under the age of 10 years old, will count towards capacity if they are present in the home.
• 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 $3,000.00 maximum per day/per person will be assessed if this regulation is violated.
• Licensee must be present in the home, 80% of operating hours. If licensee is to temporarily leave home, licensee must easily be contacted. Assistants and helpers working in the home must also have current CPR certification when left alone with the children.
• To provide copy of the Evaluation Report that documents any Type “A” deficiencies to the parents/guardians of children currently enrolled in care and to any newly enrolled parents/guardians for 12 months from the date of the report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child’s file for verification.

Licensee stated they aware of the importance to be in compliance with all licensing regulations.

A plan of correction visit was completed 11/08/2022. Deficiencies issued have since been cleared.

Exit interview conducted and report was reviewed with the licensee, Yang “CoCo” Xiao.

Report was read out loud during the virtual meeting. Report will be emailed to licensee to email address on file. Confirmation of receipt is required.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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