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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420743
Report Date: 10/03/2024
Date Signed: 10/03/2024 11:14:06 AM

Document Has Been Signed on 10/03/2024 11:14 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:TAN, YUE SHANFACILITY NUMBER:
013420743
ADMINISTRATOR/
DIRECTOR:		TAN, YUE SHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 378-5118
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:01 AM
MET WITH:Yue-Shan TanTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On October 03, 2024 8:01am Licensing Program Analyst (LPA) Randy Miranda arrived unannounced to conduct an annual inspection for health and safety. Present for today’s inspection was the licensee, 2 fingerprint and TB cleared assistants, and 11 children in care (2 infants; 6 two years old; and 3 three years old). The licensee is in ratio today. The hours of operation are Monday through Friday, 8:00am to 6:00pm.

The facility is a single-story home with 4 bedrooms 2 bathrooms, kitchen, living room, (day care area), dining room (day care play room) an attached 2-car garage, side and backyard area. There is no fireplace in the home. Licensee owns the home.

The home is organized and clean with central heating and ventilation for safety and comfort. The outdoor play area is fenced and has artificial turf for cushioning. The area has a child fence to keep children in the patio area. All fixtures were observed to be free from defects and dangerous conditions. There were ample age appropriate toys inside and outside that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection.



ON LIMITS: Living room (day care area), dining room (day care area), Bedroom #1 (west side of home) for napping and the attached bathroom, fenced-in backyard area.
OFF LIMITS: Kitchen, Bedrooms 2, 3 and 4 (all on east side of home), main house bathroom, areas outside of fenced-in area of backyard (including side yard) and attached 2-car garage. The off-limits areas are inaccessible by closed and/or locked doors, child gates and visual supervision.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: TAN, YUE SHAN
FACILITY NUMBER: 013420743
VISIT DATE: 10/03/2024
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LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. Disaster drills are conducted every 6 months, the last one was completed on 7-18-2024. The home has a fully charged 3A40BC fire extinguisher stored in the kitchen. There is a working telephone, a combination smoke/carbon monoxide detector (tested and functioning). Per licensee, there are no firearms in the home. Licensee carries liability insurance through Acord DCI, policy is in force through 1/09/2025.

Children’s files were reviewed, a copy of the roster was taken for the office file. All children’s files were complete and in good order.

The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 5/06/2025. The licensee and her helpers completed and received a certificate in Chinese language mandated reporter training (verified AB1207), expires in June 2025 and July 2026. Licensee and helpers are in compliance with immunization laws which pertains to day care providers. LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

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.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: TAN, YUE SHAN
FACILITY NUMBER: 013420743
VISIT DATE: 10/03/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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.

There were no deficiencies issued during today’s inspection. This report will remain on file for 3 years.

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

Exit interview conducted and report was reviewed with the licensee Yue Shan Tan.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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