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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004735
Report Date: 11/07/2023
Date Signed: 11/07/2023 11:17:52 AM

Document Has Been Signed on 11/07/2023 11:17 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
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: 3DATE:
11/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Yu YangTIME COMPLETED:
10:30 AM
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On 11/7/2023 at 9:20AM., 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; plan of correction inspection. Present was the licensee caring for three children (1 preschool age, 2 infant age). LPA inspected facility for health and safety hazards.

During inspection, LPA conducted interviews, record reviewed, and observations.

Licensee has implemented infant safe sleep practices including: Review and documenting infant napping conditions every 15 minutes. Napping log were reviewed during inspection. PIN 20-24 was provided during inspection.

LPAs observed licensee operating within the required capacity limits on this day. LPAs advised licensee that an additional helper must be present in home, when operating beyond a small licensure, capacity limit. Per licensee child, C6, will not be returning.

LPAs reviewed children's and personnel records. LPAs observed, authorized representatives have signed them, LIC9224, 'Notice of A-type Deficiency'. Forms have been stored in children's records. Staff, S1, has proper association and criminal record clearance on file.

Deficiency issued on 10/12/2023, has been cleared, and letter was provided.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and report was with Licensee, Yu Yang, and signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice of site visit must remain posted for 30 days. Director was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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