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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422770
Report Date: 07/28/2022
Date Signed: 08/10/2022 10:52:00 AM

Document Has Been Signed on 08/10/2022 10:52 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:DING, LAN & MO, YA QINGFACILITY NUMBER:
013422770
ADMINISTRATOR:DING, LAN & MO, YA QINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 375-9428
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Lan DingTIME COMPLETED:
12:58 PM
NARRATIVE
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On Thursday, July 28, 2022 at 10:40 AM, Licensing Program Analyst (LPA) Caroline Colson met with Lan D, Licensee for an unannounced inspection.

The attached type A deficiency is being cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Please See LIC 809 D for Additional Information

The Notice of Site Visit was posted and must be posted for 30 days. An exit interview was conducted. Appeal rights were discussed. This report must be available for public review for 3 years.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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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Document is an Amendment of Original Document on 08/04/2022 07:21 AM


Created By: Caroline Colson On 07/28/2022 at 12:08 PM
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DING, LAN & MO, YA QING
FACILITY NUMBER: 013422770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102391(a)(3)


This requirement is not met as evidenced by:Licensee refusing to allow a department representative to conduct an inspection
Deficient Practice Statement
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POC Due Date: 07/29/2022
Plan of Correction
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Type A
Section Cited
CCR
102416.5(e)


This requirement is not met as evidenced by:Licensee is caring for four infants and one preschool child alone.
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above because she is providing care and supervision to four infants and one preschool child alone which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Licensee will reduce the number of infants or only have four infants in care.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2022


LIC809 (FAS) - (06/04)
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