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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313779
Report Date: 04/28/2023
Date Signed: 04/28/2023 05:30:32 PM

Document Has Been Signed on 04/28/2023 05:30 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
ORANGE CO CHILD CARE, 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: 6CENSUS: 5DATE:
04/28/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Mei-Yin Yu WangTIME COMPLETED:
05:50 PM
NARRATIVE
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An unannounced Case Management visit was conducted on this date by Licensing Program Analysts (LPA's) Thompson and Duron for inspecting the home to ensure that no children were present and being cared for. The purpose of today's visit is to ensure that Mei-Yin Yu Wang have ceased operation of her Family Child Care as stated in the Decision and Order CDSS No. 6622234101 that became effective March 24, 2023.

This report dated 4/28/2023 was translated in Mandarin using Language Link at 4:56 PM.

Wang, Ye-Wei and Yu, Mei-Yin’s Family Child Care Home license was revoked upon the Department’s adoption of this Stipulation as its Order on 3/24/2023. In addition, Ms. Yu has ninety (90) days from the adoption of this Stipulation to complete training related to the allegations contained in the detailed below:
I. Positive Discipline, one day course and,
II. Parenting, a 6-8 week course.

Within thirty (30) days after completing this requirement, Ms. Yu shall submit to the licensing office a copy of the certification of completion.

LPA's Thompson and Duron reviewed and provided Ms. Yu a copy of the Stipulation and Waiver; and Order effective March 24, 2023.

Upon arrival at 1:15 PM , LPA's met with assistants who LPA's observed caring for five (five) children, four observed to be infants. Licensee Mei-Yin Yu Wang arrived at 2:15 PM


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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: WANG, YU-WEI & YU, MEI-YIN
FACILITY NUMBER: 304313779
VISIT DATE: 04/28/2023
NARRATIVE
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A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Three assistants present were unable to provide LPA's personnel records. Assistants present were missing CPR and FIrst Aid Certification, LIC 9052 Employee Rights, Proof of Immunization, TB Clearance, LIC 9108 Statement Acknowledging to Report Child Abuse. Licensee and assistants present were unable to provide proof of their mandated reporter certification.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.

While touring the facility, LPA's observed blankets inside the cribs while children were asleep. LPA's also observed one infant laying on their stomach inside the crib while sleeping.



Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and Immunization records.

Licensee was unable to provide a current roster for children in care. Affidavit Regarding Liability Insurance (LIC282), Consent for Emergency Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995A) were missing from children files. Child (C1) was missing LIC 9227 Individual Infant Sleeping Plan and all four infants were missing documentation showing napping log is being documented.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: WANG, YU-WEI & YU, MEI-YIN
FACILITY NUMBER: 304313779
VISIT DATE: 04/28/2023
NARRATIVE
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***The purpose of this visit on 5/19/23 is to Amend the original report created on 4/28/23. This is an amended report due to all deficiencies made in error***


In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.


Exit interview conducted and report was reviewed with the licensee Mei-Yin Yu Wang. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Appeal Rights and deficiencies were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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Page: 2 of 9
Document Has Been Signed on 04/28/2023 05:30 PM - It Cannot Be Edited


Created By: Dean Thompson On 04/28/2023 at 03:55 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: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2023
Section Cited
CCR
102416(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.

This requirement is not met as evidenced by:
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Licensee stated she will submit proof to LPA by POC due date.
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Based on record review, the licensee did not comply with the section cited above.
At the time of arrival at 1:15 PM, all three assistants present did not have proof showing they completed CPR and First Aid training which poses an immediate 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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


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Document Has Been Signed on 04/28/2023 05:30 PM - It Cannot Be Edited


Created By: Dean Thompson On 04/28/2023 at 03:59 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: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited
CCR
102416.1(d)

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(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
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Licensee stated she will submit personnel records to LPA by POC due date.
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Based on interview and record review, the licensee did not comply with the section cited above.Three assistants present were unable to provide LPA's personnel records. Assistants present were missing CPR and FIrst Aid Certification, LIC 9052 Employee Rights, Proof of Immunization, TB Clearance, LIC 9108 Statement Acknowledging to Report Child Abuse, and Mandated Reporter Training Certificates which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/12/2023
Section Cited
CCR102419(d)

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(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
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Licensee stated she will submit missing LIC 995A Notification of Parent Rights to LPA by POC due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. During children file review, LPA's observed all five children present were missing LIC 995A Notification of Parent Rights 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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


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Document Has Been Signed on 04/28/2023 05:30 PM - It Cannot Be Edited


Created By: Dean Thompson On 04/28/2023 at 04:07 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: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited
CCR
102417(g)(7)

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(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
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Licensee stated she will submit missing LIC 627 Consent for Emergency Medical Treatment form to LPA by POC due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. During children file review, LPA's observed all five children present were missing LIC 627 Consent for Emergency Medical Treatment form which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/01/2023
Section Cited
HSC102417(8)(A)

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102417 Operation of a Family Child Care Home (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. (A) Health and Safety Code Section 1596.841 states:
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 child's physician. This roster shall be available to the licensing agency upon request.
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The licensee stated she would complete the roster by the due date of 5/1/2023 and would submit proof to LPA.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. Licensee was unable to provide a current roster for children in care 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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


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Page: 6 of 9
Document Has Been Signed on 04/28/2023 05:30 PM - It Cannot Be Edited


Created By: Dean Thompson On 04/28/2023 at 04:18 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: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
102425(b)

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(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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LPA observed blankets being removed at the time of visit.
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Based on observation, the licensee did not comply with the section cited above. While touring the facility, LPA's observed blankets inside the cribs while children were asleep which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/12/2023
Section Cited
HSC1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
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Licensee stated she and her assistants will complete the training and submit proof to LPA by POC due date.
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Based on observation, interview, and record review,, the licensee did not comply with the section cited above. Licensee and assistants present were unable to provide proof of their mandated reporter certification 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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


LIC809 (FAS) - (06/04)
Page: 7 of 9
Document Has Been Signed on 04/28/2023 05:30 PM - It Cannot Be Edited


Created By: Dean Thompson On 04/28/2023 at 04:24 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: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited
CCR
102417(m)(3)

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(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
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Licensee stated she will submit missing LIC 282 Affidavit Regarding Liability Insurance to LPA by POC due date
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. During children file review, LPA's observed all five children present were missing LIC 282 Affidavit Regarding Liability Insurance which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/12/2023
Section Cited
CCR102425(c)(2)

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An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
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Licensee stated she will submit missing LIC 9227 Individual Sleeping Plan to LPA by POC due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. During children file review, LPA's observed C1 was missing LIC 9227 Individual Sleeping Plan form 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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 04/28/2023 05:30 PM - It Cannot Be Edited


Created By: Dean Thompson On 04/28/2023 at 04:29 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: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
102425(d)

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The provider shall place infants up to 12 months of age on their backs for sleeping.

This requirement is not met as evidenced by:
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LPA observed assistant place infant on their back at the time of visit.
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Based on observation, the licensee did not comply with the section cited above.
While touring the facility, LPA's observed one infant laying on their stomach inside the crib while sleeping which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
04/28/2023
Section Cited
CCR102425(j)(2)(D)(c)

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Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
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Licensee stated she will document infant safe sleep for all infants in care and submit proof to LPA by POC due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA observed safe sleep logs for 2 out of 3 infants. The 2 infants that did have a safe sleep log hasnt been documented since 12/16/2022 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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


LIC809 (FAS) - (06/04)
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