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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421494
Report Date: 11/28/2023
Date Signed: 11/28/2023 02:41:29 PM

Document Has Been Signed on 11/28/2023 02:41 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:TSAI, YIWENFACILITY NUMBER:
013421494
ADMINISTRATOR:TSAI, YIWENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 717-0127
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
11/28/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Yiwen Tsai TIME COMPLETED:
03:00 PM
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On 11/28/2023 at 12:55pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Yiwen Tsai for an Unannounced Required Inspection. Present during the inspection were two infants and four preschoolers in care with an additional finger print cleared assistant. Residing in the home is Licensee, her fingerprint cleared husband and two underage child. Licensee’s home was toured for a health and safety inspection. The facility operates 7:30am – 5:30pm, Monday - Friday.

The home is a split level home that consists of three bedrooms and one and half bathrooms. The entrance to the day care is the front door. The inside and outside of the home were observed to be have age-appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. During today’s inspection, LPA observed the following precautions the off limit areas have latches on the door and the stairs in the home have gates to prevent a fall. Licensee has stated that there are no firearms and no pets in the home.


ON LIMITS AREA: The living room , which is the main area of the day care, the dining room, the half bathroom next to the hallway, the lower bedroom which is the nap room, and areas of the fenced in backyard.
OFF LIMITS AREA: the two bedrooms upstairs, the basement, the kitchen, the full bathroom, the deck, the left side of the of the backyard and the area under the deck, which will be inaccessible by closed and/or locked doors or visual supervision.
ISOLATION AREA: the living room on the couch.

The home has a fully charged 3A40BC fire extinguisher in the kitchen, a working smoke detector and carbon monoxide detector in the hallway. Licensee has a working telephone, and all required forms are posted. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 11/15/23 The Licensee's CPR and First Aid certificate is current and expires on 5/20/25.
REPORT CONTINUES ON 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: TSAI, YIWEN
FACILITY NUMBER: 013421494
VISIT DATE: 11/28/2023
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The Licensee was reminded of the responsibility as a mandated reporter and will provided proof of the required training for all people caring for children. LPA did not observe a body of water in or around the home. LPA reviewed four the children’s files and two files and obtained a current facility roster.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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 informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

REPORT CONTINUES ON 809C.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: TSAI, YIWEN
FACILITY NUMBER: 013421494
VISIT DATE: 11/28/2023
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 Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were observed during today's inspection

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

Exit interview conducted and report was reviewed with the licensee

Appeal rights, report and Notice of site visit provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6