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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407985
Report Date: 11/08/2023
Date Signed: 11/08/2023 04:27:21 PM

Document Has Been Signed on 11/08/2023 04:27 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:YANG, FE FAMILY CHILD CARE HOMEFACILITY NUMBER:
455407985
ADMINISTRATOR:YANG, FEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 881-6590
CITY:PALO CEDROSTATE: CAZIP CODE:
96073
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
11/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:58 PM
MET WITH:Fe"Mindy"YangTIME COMPLETED:
04:36 PM
NARRATIVE
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On 11/8/23 Licensing Program Analyst (LPAs) Mendez and Dutra met with licensee and conducted a case management visit.
During an inspection conducted at the facility on 11/8/23 @ 3:58pm Licensing Program Analysts (LPA’s) Mendez and Dutra observed that the conditions of the pool waiver were not met, there is a faulty door lock on the back sliding door and there are no door alarms. The inground pool has a chain link fence and it was observed that there was a gaping hole at the bottom of the fence covered with cement blocks. Therefore making bodies of water accessible to children in care.

Based on the observation made, the following deficiencies are being cited: Accessible bodies of water,
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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 11/08/2023 04:27 PM - It Cannot Be Edited


Created By: Bianca Mendez On 11/08/2023 at 03:58 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: YANG, FE FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407985

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/08/2023
Section Cited
HSC
102417(g)(5)

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:
All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
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Licensee will correct the following and ensure that bodies of water are inaccessible to children and replace door alarms, fence will be fixed where there is a hole. Licensee will email POC to CCLD by 11/9/23.
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Based on observation: licensee did not meet the requirements of the pool waiver on file, there is a faulty door lock on the sliding door and there are no active door alarms.
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A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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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:Megan Aviles
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: YANG, FE FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407985
VISIT DATE: 11/08/2023
NARRATIVE
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LPA Mendez informed licensee, Fe Yang , that this report dated 11/8/23 documents 1 Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Mendez informed the licensee to provide a copy of this licensing report dated 11/8/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with licensee, Fe Yang and appeal rights were provided.

Notice of Site visit shall remain posted for 30 days.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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