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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700163
Report Date: 08/12/2021
Date Signed: 08/12/2021 10:25:22 AM

Document Has Been Signed on 08/12/2021 10:25 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:CAO, YANLIFACILITY NUMBER:
015700163
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Yanli CaoTIME COMPLETED:
10:44 AM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct an UNANNOUNCED REQUIRED 1 YEAR AND CAPACITY INCREASE INSPECTION. LPA was met by Licensee Yanli Cao and to assist with the visit and to help with translation present was Yukiko Tsuruta. Licensee speaks primarily speaks Mandarin. No children were present during today's visit.

LPA conducted a health & safety inspection of the facility. The day care resides in a two story home. The ON LIMIT areas are: the living room, backyard and hallway bathroom. The OFF LIMITS areas are: Kitchen, Family room, covered patio, garage and the entire second floor. There are no firearms on the premises as stated by the applicant. LPA verified that the home phone is in working condition. The home is properly ventilated for children's safety and comfort. There are appropriate toys and kids furniture that are safe to use and appeared to be well maintained. The applicant has completed the required training of preventive health practices including pediatric CPR and First Aid. LPA reviewed the facility file and all children files of children currently enrolled. Licensee is conducting fire/disaster drills per regulation. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates. Individual Medication Services (IMS) were discussed with Licensee.

The fire clearance for the increase in capacity has a conditional approval received on 7/30/2021 with the following conditions:

-.garage is off limits
- second story is off limits
- outdoor patio cover is off limits
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2021
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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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: CAO, YANLI
FACILITY NUMBER: 015700163
VISIT DATE: 08/12/2021
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No deficiencies are being cited. This home is recommended for the capacity increase as of today's date. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. This report shall remain on file for 3 years. Exit interview conducted with licensee. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC809 (FAS) - (06/04)
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