<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419929
Report Date: 10/10/2024
Date Signed: 10/10/2024 12:15:18 PM

Document Has Been Signed on 10/10/2024 12:15 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WANG, YIHANFACILITY NUMBER:
013419929
ADMINISTRATOR/
DIRECTOR:		WANG, YIHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 828-3888
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee. Yihan WangTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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 were Licensee and her daughter supervising two (2) infants and six (6) preschoolers. The Licensee primarily speaks Mandarin. The Licensee’s daughter, Ting Ting Chen, who also works and resides in the same house, helped LPA translate and inspect the facility. The two-story home has five bedrooms, 4.5 bathrooms, a living room, kitchen, dining area, garage, and backyard. The hours of operation are 700AM- 6:00 PM, Monday -Friday. The facility has a liability insurance through Mercury Insurance.
On-limit areas are : the large playroom, kitchen, and bathroom #1, located next to the main entrance and backyard. Per Licensee, she no longer utilizes the backyard; however, she uses the nearby park (Ted Fairfield Park) for the outdoor play area. The Licensee is reminded that 100% visual and physical supervision is required when going to and from the park.
Off Limit areas are: the entire 2nd floor and the garage. All the off-limit areas are made inaccessible by closed and/or locked doors and visual supervision.
LPA observed the following: The Daycare Area is equipped with age-appropriate toys. The home has a working telephone and a fire extinguisher and carbon Monoxide that meets the minimum requirements. During the inspection, LPA did not observe any bodies of water. The two fireplaces are screened to prevent access by children. There are child-size tables and chairs for snacks and activities. There are ample age-appropriate toys that appear to be safe and in good condition. Each child has their separate cribs and blankets. Per Licensee, The blankets are washed weekly by the Parents. The Licensee states there are no guns or weapons of any kind in the home. A safety gate is in place at the bottom of the stairs to prevent access to the upstairs area. The licensee provides daily snacks and meals. LPA reviewed children’s files. All required postings are properly posted. The Licensee will complete the required mandated reporter training when it is offered in her primary language. http://www.mandatedreporterca.com/
see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: 10/10/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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

Three Type B deficiencies are cited today(see attached LIC809-D).

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: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/10/2024 12:15 PM - It Cannot Be Edited


Created By: Jyoti Saini On 10/10/2024 at 11:11 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: 10/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. Out of the eight children present, three were missing immunizations on the file, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 10/17/2024
Plan of Correction
1
2
3
4
The licensee shall email proof of the children's immunization to the community care licensing division
(CCLD) by 10/17/2024.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. Three of the eight children present were missing emergency information cards as required in the file, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 10/17/2024
Plan of Correction
1
2
3
4
The licensee shall email proof of the children's emergency information cards to the community care licensing division ( CCLD) by 10/17/2024.
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: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/10/2024 12:15 PM - It Cannot Be Edited


Created By: Jyoti Saini On 10/10/2024 at 11:11 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: 10/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. The facility roster was incomplete which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 10/14/2024
Plan of Correction
1
2
3
4
The facility shall submit a copy of the complete roster to the Community Care Licensing Division
(CCLD) by 10/14/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4