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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019963
Report Date: 07/30/2024
Date Signed: 07/30/2024 10:23:10 AM

Document Has Been Signed on 07/30/2024 10:23 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:YEH & HSU FAMILY CHILD CAREFACILITY NUMBER:
198019963
ADMINISTRATOR/
DIRECTOR:
WILLIAM HSU & FAY YEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 236-8095
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
07/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Fay Yeh, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Roxana Lopez and Saul Valenzuela conducted an unannounced Case Management inspection due to an incident that was reported to the Department on 07/01/2024. LPAs met with Licensee Fay Yeh who guided LPAs on a tour of the facility. Census was taken.

On July 1st, 2024, an incident was self-reported to the Department via Phone by the facility who reported a child sustained a cut on their eyebrow on June 16th, 2024.



The report was not reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incident and the reason for Licensee not reporting to the Department.

During the inspection, LPAs conducted interview and record review of staff files with Licensee. Regarding the incident first aid was administered and mother took child to Hospital for a checkup, no stitches were required. At 9;35 am during record review, LPAs observed that Licensee and their two assistants CPR / First Aid did not have the required Pediatric CPR / First Aid training completed. Per Licensee, their assistant was unaware of the Reporting Requirements at the time of the incident. Per Licensee she has very limited knowledge of the reporting requirements. Licensee states that in the past she has reached out to the Department and never received a response. LPA discussed the Reporting Requirements with Licensee. LPA provided Licensee with the Monterey Park Regional Office Incident Reports email to ensure that reporting requirements are being met.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.



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

Exit interview conducted and report was reviewed with Licensee, Fay Yeh.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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Document Has Been Signed on 07/30/2024 10:23 AM - It Cannot Be Edited


Created By: Saul Valenzuela On 07/30/2024 at 09:52 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: YEH & HSU FAMILY CHILD CARE

FACILITY NUMBER: 198019963

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2024
Section Cited
CCR
102416.2(a)

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(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).
This requirement is not met as evidenced by
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LIcensee provided the department the written report LIC 624. Per Licensee and assistants will review the reporting requirements for Family Child Care Home and provide LPA a written statement that they reviewed the regulation by 8/8/2024.
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Based on interview, the licensee did not comply with the section cited above that Licensee did not report the incident that occurred on 6/14/2024 within the next business day, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
08/29/2024
Section Cited
CCR102416(C)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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Per Licensee they will register for a class for Pediatric CPR / FIrst Aid and will submit the completed certificates to LPA via email by 8/29/2024.
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Based on record review, the licensee did not comply with the section cited above in 3 out of 3 staff did not have a completed Pediatric CPR and First aid, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024


LIC809 (FAS) - (06/04)
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