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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419929
Report Date: 08/25/2022
Date Signed: 08/25/2022 01:21:10 PM

Document Has Been Signed on 08/25/2022 01:21 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WANG, YIHANFACILITY NUMBER:
013419929
ADMINISTRATOR:WANG, YIHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 828-3888
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Licensee, Yihan Wang TIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with licensee Yihan Wang for an unannounced POC. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee and helper supervising 4 infants and 2 preschoolers. LPA reviewed the roster and obtained a copy. Licensee is within the capacity ratio during today's inspection. LPA Saini cleared deficiency cited on 08/18/2022 for the facility being over capacity.

There are no deficiencies cited today. Copy of Cleared POC letters were provided. An exit interview was conducted with licensee, Yihan Wang. A notice of site visit was posted. Notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
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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