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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004735
Report Date: 10/12/2023
Date Signed: 10/12/2023 04:59:23 PM

Document Has Been Signed on 10/12/2023 04:59 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:YANG, YUFACILITY NUMBER:
414004735
ADMINISTRATOR:YANG, YUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 922-8838
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yu YangTIME COMPLETED:
05:10 PM
NARRATIVE
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On 10/12/2023 at 1:30PM., Licensing Program Analysts (LPAs), Luis J. Gomez and Man Tso, met with Licensee, Yu Yang. Purpose of the inspection was explained and was for an Unannounced; Annual Random. Present in home was the licensee caring for 6 children. Licensee’s home is a 3 bedroom, 2 bathroom, 1 level house. Days and hours of operation are Monday- Friday, 8:30AM- 5:30PM. Day care areas are: Living Room (Playroom), Bathroom #1, and Dining Area. Off Limit Area: Bedroom #1, #2, #3, Bathroom #2, Kitchen, and Backyard Area. LPAs inspected home with licensee for health and safety hazards.

At 1:35PM., the following was observed: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors/ground surfaces were clear of obstructions or hazards. Accessible children’s furniture, toys, and books inspected were in good repair.

At 1:40PM., Based on observations, LPAs confirmed child, C1, awake in napping crib.


At 1:45PM., Based on observations and record review, LPAs confirmed licensee utilizing off-limit bedrooms, #1, #2, for napping services.

Playroom has child sized tables and chairs for seated activities. For napping services, LPAs observed several cribs and play pens in the facility. LPAs observed one crib, with tight- fitting sheet, available for each infant in care. The fireplace has been barricaded.

Bathroom #1 was clean with adequate supplies for hand washing. Facility was the proper temperature with lighting and ventilation. Home had functioning telephone service; smoke detector; carbon monoxide detector; and fire extinguisher: 2A:10BC. Pull handle fire alarm was located next to entry way. (REFER TO 809C, FOR CONT)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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 10/12/2023 04:59 PM - It Cannot Be Edited


Created By: Luis Gomez On 10/12/2023 at 03:29 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YANG, YU
FACILITY NUMBER: 414004735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:45PM., Based on record review, interview and observations, LPAs confirmed licensee is operating over capacity with 5 infants in care. This poses an immediate health and safety risk to children in care.
POC Due Date: 10/13/2023
Plan of Correction
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Licensee will lower her total enrollment to required 4 infant by the due date: 10/13/2023. Updated children shedule and children's roster will be submitted to the the department via email.

Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/12/2023 04:59 PM - It Cannot Be Edited


Created By: Luis Gomez On 10/12/2023 at 03:29 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YANG, YU
FACILITY NUMBER: 414004735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(e)
Infant Safe Sleep
No infant shall be forced to sleep, to stay awake, or to stay in the designated sleeping area.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 1:40PM., Based on observations, LPAs confirmed child, C1, awake in napping crib. This poses a potential health and safety risk to children in care.
POC Due Date: 10/16/2023
Plan of Correction
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Licensee will review Safe Sleep Regulations PIN 20-24 CCP by the due date: 10/16/2023
Proof of correction will be submitted to the department via email.
Type B
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 3:15PM., Based on record review, interview, and observations, LPAs confirmed assistant present without proper criminal record clearances on file. This poses a potential health and safety risk to children in care.
POC Due Date: 10/16/2023
Plan of Correction
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Licensee will ensure all staff received proper criminal record clearance and association prior to presence with children.

Proof of correction will be submitted to the department via email.
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 10/12/2023 04:59 PM - It Cannot Be Edited


Created By: Luis Gomez On 10/12/2023 at 03:29 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YANG, YU
FACILITY NUMBER: 414004735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:55PM., Based on record review and interview, LPA confirmed licensee is not documenting infant napping conditions during each 15-minute review. This poses a potential health and safety risk to children in care.
POC Due Date: 10/16/2023
Plan of Correction
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Licensee will review Safe Sleep Regulations PIN 20-24 CCP; begin documenting infant napping conditions every 15 minutes, by the due date: 10/16/2023

Proof of correction will be submitted to the department via email.
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:10PM., Based on interview, record review, and observations, LPA confirmed licensee is operating beyond required capacity limits, without a helper present. This poses a potential health and safety risk to children in care.
POC Due Date: 10/16/2023
Plan of Correction
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Licensee will submit updated staff and children's schedule, ensuring that licensee when operating beyond a small capacity, helper is present to assist.

Proof of correction will be submitted by the due date: 10/16/2023.
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 10/12/2023 04:59 PM - It Cannot Be Edited


Created By: Luis Gomez On 10/12/2023 at 03:53 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YANG, YU
FACILITY NUMBER: 414004735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(2)
Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 1:45PM., Based on observations and record review, LPA confirmed licensee utilizing off-limit bedrooms, #1, #2, for napping services. This poses a potential health and safety risk to children in care.
POC Due Date: 10/16/2023
Plan of Correction
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Licensee will submit an updated LIC999 to the department showing on/ off limit areas. Subsequent inspection will be done to add bedrooms to the day-care.

Proof of correction will be submitted to the department via email
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YANG, YU
FACILITY NUMBER: 414004735
VISIT DATE: 10/12/2023
NARRATIVE
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(Page 2)
Facility does not have any pools, fishponds, or other bodies of water.

At 2:05PM, LPAs reviewed facility and children’s records. Children’s files were reviewed and included the: Notification of Parent's Rights (LIC995); Identification of Emergency Information (LIC702); and Consent for Medical Treatment

At 2:10PM., Based on interview, record review, and observations, LPAs confirmed licensee is operating beyond required capacity limits, without a helper present.



At 2:45PM., Based on record review, interview and observations, LPAs confirmed licensee is operating over capacity with 5 infants in care.

At 2:55PM., Based on record review, LPAs confirmed licensee is not documenting infant napping conditions during each 15-minute review.

Staff records were reviewed and included the: Proof of required immunization.

At 3:15PM., Based on record review, interview, and observations, LPAs confirmed helper present without proper criminal record clearances on file.

Licensee's Cardiopulmonary Resuscitation (CPR)/ First Aid certification was current, expiring: 1/2024.
Licensee ‘Mandated Reporter Training’ (AB1207) was current, expiring: 3/7/2025.

Licensee to conducted emergency disaster drills every six months with last one done: 5/5/2023. LPAs reminded licensee to log each drill done on site.

Required forms are posted in entry way, including the Childcare License; Notification of Parent’s Rights (PUB379); Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill children in care, is in playroom.

Per licensee, parents provides food items for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled. Per licensee, home does not have any firearms.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YANG, YU
FACILITY NUMBER: 414004735
VISIT DATE: 10/12/2023
NARRATIVE
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(Page 3)
LPAs discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for IMS must be submitted to the department. the following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514-0301 (voice)/ (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3 Health and Safety Code of Regulations and cited on 809D. LPA conducted exit interview, appeal rights, plan of correction, report was reviewed with licensee, Yu Yang. Licensee’s signature of this form acknowledges receipt of these documents.

Type “A” violation was issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

Notice of Site Visit was provided and must remain posted for 30 days.

During exit interview, licensee, Yu Yang confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
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