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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700332
Report Date: 05/16/2022
Date Signed: 05/16/2022 08:46:50 AM

Document Has Been Signed on 05/16/2022 08:46 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:
015700332
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
05/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:16 AM
MET WITH:Yi Rou He- LicenseeTIME COMPLETED:
08:55 AM
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On 5/16/22 at 8:16am, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced Case Management Inspection with Licensee Yi Rou He. Present for the inspection was 6 children in care as well as fingerprint clear assistants Huanchi Dong and Lian Xi Xu. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am until 6:00pm. The Family Childcare Home is located at its own address at 4363 James Ave. Castro Valley, CA 94546 behind 4365 James Ave. Castro Valley, CA 94546. Both homes are on the same lot and owned by the licensee. To enter the childcare, licensee stated families will be let in the side gate and walk to the home located in back of the front house.

The OFF LIMIT AREAS are the small room located to the right of the bathroom, the kitchen, and the back room which will be inaccessible by closed and/or locked doors and visual supervision. There is a child safety gate in place to prevent access to the kitchen. The ON LIMIT AREAS are the bathroom, living room, and bedroom located next to the kitchen. The ISOLATION AREA will be the first bedroom located next to the kitchen. Outdoor play area will be in the fenced backyard which has its own sink. The childcare has its own backyard which can be located through the living room. The outdoor area located between the front and back home will not be utilized by children in care except when the licensee or families in care are dropping off or picking up the children in care. The garden located on the right of the back backyard will not be utilized by children in care. There are toys that are safe and appeared to be clean. There are no pools, hot tubs or any other bodies of water on the premises.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's Health and Safety training is completed and CPR and First Aid certificate is current and expires 04/17/23. The licensee is in compliance with new immunization law which pertains to day care providers. The licensee currently has a waiver for mandated reporter training until it is available in Cantonese.
See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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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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: HE, YI ROU
FACILITY NUMBER: 015700332
VISIT DATE: 05/16/2022
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On 05/13/22, a fire clearance was granted to facility #015700332 by Alameda County Fire Department. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .

As of 5/16/22, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. This entire report has been read to the Licensee by LPA Plumboy. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Plumboy or CCLD. An exit interview was conducted, and appeal rights provided.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC809 (FAS) - (06/04)
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