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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420743
Report Date: 07/25/2022
Date Signed: 07/25/2022 12:47:01 PM

Document Has Been Signed on 07/25/2022 12:47 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:TAN, YUE SHANFACILITY NUMBER:
013420743
ADMINISTRATOR:TAN, YUE SHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 378-5118
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
07/25/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Yue Shan TanTIME COMPLETED:
12:50 PM
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On July 25, 2022 at approximately 11:20 am, LPA Haderer arrived unannounced to verify the corrections requested from the July 8, 2022 annual inspection have been completed. Present today was the licensee, her two fingerprint cleared and associated assistants and 12 children in care (1 twenty-three months old, 5 two-years old; 6 three-years old). The facility is in ratio today.

The Facility Child Care Roster was available and filled out completely.

All children's files were reviewed and all required forms were available.

All deficiencies were cleared and clearance letters issued.

A Notice of Site Visit was printed and must remain posted for 30 days.
.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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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