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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421632
Report Date: 08/09/2021
Date Signed: 08/09/2021 11:27:41 AM

Document Has Been Signed on 08/09/2021 11:27 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HE, YI ROUFACILITY NUMBER:
013421632
ADMINISTRATOR:HE, YI ROUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 867-7369
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yi Rou He- LicenseeTIME COMPLETED:
11:35 AM
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On 8/9/21 Licensing Program Analysts (LPA) Briana Plumboy met with licensee Yi Rou He for an UNANNOUNCED CASE MANAGEMENT INSPECTION. Present for this inspection was 5 preschool age children, licensee's teenage daughter, as well as 4 fingerprint clear assistants. LPA B. Plumboy toured the facility and conducted a physical census of the children in care.

As of 8/9/21, LPA Plumboy removed licensee from required visits. Licensee has met most licensing requirements over the last 3 years.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2021
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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