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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313844
Report Date: 03/04/2022
Date Signed: 03/04/2022 10:00:38 AM

Document Has Been Signed on 03/04/2022 10:00 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:YANG, LINFACILITY NUMBER:
304313844
ADMINISTRATOR:YANG, LINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 656-1150
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/04/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lin YangTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Plan of Correction (POC) inspection. LPA and the facility representative toured the facility. Census was taken. The overall census observed was 9 children and 3 adults total providing care. This POC inspection is being done in response to 2 A violations cited on 2/24/22, in which the facility had 15 children in care, and briefly 16 children in care. In addition, the facility had 15 children in care without a child attending kindergarten or older. These violate ratio and capacity regulations, and are determined to be immediate risks to children's health and safety. During today's inspection, it was observed that the facility was in compliance of ratio and capacity regulations and the facility has corrected these A violations.

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.

Appeal Rights and deficiencies were discussed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2022
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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