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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416822
Report Date: 11/06/2024
Date Signed: 11/06/2024 02:27:18 PM

Document Has Been Signed on 11/06/2024 02:27 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:YANG, SIYAOFACILITY NUMBER:
434416822
ADMINISTRATOR/
DIRECTOR:		SIYAO, YANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 619-0812
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
11/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Siyao YangTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Marilou Monico conducted a Case Management Inspection to deliver an amended Facility Evaluation Report (LIC 809D) dated 08/26/24 and obtain licensee's signature on the report. LPA met with Licensee, Siyao Yang, and explained to her the purpose of today's inspection. LPA toured the facility. Also present in the home were three adult helpers and 12 daycare children: 4 infants and 8 preschool age.

LPA observed that all adults present in the home have fingerprint clearances associated to the facility.

There were no deficiencies cited.

A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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