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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419929
Report Date: 08/30/2023
Date Signed: 08/30/2023 11:06:39 AM

Document Has Been Signed on 08/30/2023 11:06 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
OAKLAND SOUTH EAST, 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: 7DATE:
08/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Yihan WangTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, Yihan Wang for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee and her daughter supervising two (2) infants and five (5) preschoolers. The licensee primarily speaks Mandarin. The licensee’s daughter, Ting ting, Chen who also works and resides in the same house, helped LPA translating and inspect the facility. The home is two story which consist of 5 bedrooms, 4.5 bathrooms, living room, kitchen, dining area, garage, and backyard. The hours of operation are 700AM- 6:00PM, Monday -Friday.

On-limit-areas are : the large play room, kitchen, and bathroom #1 located next to main entrance and backyard.


Off Limit areas are: the entire 2nd floor and the garage. All the off-limit area is made inaccessible by closed and/or locked doors and visual supervision.
LPA observed the following: Daycare Area is clean, orderly, and equipped with age-appropriate toys. Home has a working telephone, and a fire extinguisher that meets the minimum requirements. There are no bodies of water. The two fireplaces are screened to prevent access by children. There are child size tables and chairs for snack and activities. There are ample of age-appropriate toys that appear to be safe and in good condition. Licensee was instructed that smoking, baby bouncers, exersaucers, baby walkers and similar items are prohibited in the facility during day care hours. The napping room had cots in good condition and each child have their separate blankets. The blankets are washed weekly by the Parents. Licensee states there are no guns or weapons of any kind in the home. The backyard play area is fenced. Per licensee, the facility does not utilize backyard anymore. The licensee stated that she uses the nearby park (Ted Fairfield Park) for the outdoor play area and licensee is reminded that 100% visual and physical supervision is required when going to and from the park. There is a safety gate in place at the bottom of the stairs to prevent access to the upstairs area.Licensee and helper have current CPR. Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children’s files. All required postings are properly posted.he licensee will complete the required mandated reporter training when it is offered in her primary language.
see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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 08/30/2023 11:06 AM - It Cannot Be Edited


Created By: Jyoti Saini On 08/30/2023 at 10:18 AM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WANG, YIHAN
FACILITY NUMBER: 013419929

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. During the inspcetion,LPA observed that this facility does not have a functioning carbon Monoxide detector, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2023
Plan of Correction
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Licensee agrees to provide proof of the presence of a working carbon monoxide detector present at this facility by the POC date
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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023


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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WANG, YIHAN
FACILITY NUMBER: 013419929
VISIT DATE: 08/30/2023
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During Inspection, Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://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 reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

Type B deficiency cited today(see attached LIC809-D) and three (3) technical violations were given.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Yihan Wang.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC809 (FAS) - (06/04)
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