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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313779
Report Date: 08/01/2022
Date Signed: 08/01/2022 10:36:37 PM

Document Has Been Signed on 08/01/2022 10:36 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:WANG, YU-WEI & YU, MEI-YINFACILITY NUMBER:
304313779
ADMINISTRATOR:WANG, Y. & YU, M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 480-8866
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
08/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Licensee, Yu, Mei-Yen, and assistant, Cainan WangTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of this facility. LPA met with co-licensee, Yu, Mei-Yin. According to Ms. Yu, the other co-licensee, Wang, Wei does not currently reside at the house. The Covid-19 Emergency Response questionnaire was answered. There were a total of 10 children of whom one was under 24 months old, 2 were school age, and the rest were preschool age.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
During today's case management inspection and file reviewing, LPA found out that the licensee did not have any roster of children. This was cited on 809D next page.

The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/2016) and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report. Exit interview was conducted.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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 Has Been Signed on 08/01/2022 10:36 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 08/01/2022 at 03:14 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: WANG, YU-WEI & YU, MEI-YIN
FACILITY NUMBER: 304313779

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2022
Section Cited
HSC
102417(8)(A)

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the
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The licensee, Yu, Mei-Yin stated she would complete the roster by the due date of 8/4/2022 and would email it to LPA's email address which was provided to licensee.
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child's physician. This roster shall be available to the licensing agency upon request. Today at 2:45 pm, the licensee admitted that she did not have any roster of children. This is a potential risk to the health and safety of children 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:Rina Lopez
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2022


LIC809 (FAS) - (06/04)
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