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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700163
Report Date: 04/07/2022
Date Signed: 04/07/2022 12:52:47 PM

Document Has Been Signed on 04/07/2022 12:52 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:CAO, YANLIFACILITY NUMBER:
015700163
ADMINISTRATOR:CAO, YANLIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 598-7058
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
04/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Yukiko TsurutaTIME COMPLETED:
01:00 PM
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On 4/7/2022 Licensing Program Analysts (LPAs) Jaylena Miller and April Wright conducted a case management inspection and met with Yukiko Tsuruta on behalf of Licensee Yanli Cao for the purpose of translation. Present for the inspection were 2 staff and 12 preschool children eating lunch.

No deficiencies cited today. A notice of site visit was given and must be posted for 30 days and this report shall remain on file for 3 years. Exit interview conducted with Yukiko Tsuruta, a copy of this report, appeals rights, and signature acknowledges receipt.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2022
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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