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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419949
Report Date: 07/22/2021
Date Signed: 07/22/2021 02:46:06 PM

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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:ZHANG, WEIFACILITY NUMBER:
013419949
ADMINISTRATOR:ZHANG, WEIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 552-3035
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:14CENSUS: 5DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Wei ZhangTIME COMPLETED:
03:05 PM
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(1) Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct a Required - 1 Year inspection on today's date, 7/22/2021. LPA was met by Licensee Wei Zhang. Present during today's visit was the Licensee's fingerprint cleared spouse and 5 children (1 School Age, 4 preschoolers). LPA conducted a health and safety inspection inside and outside at 1:25PM.

ON LIMIT AREAS: NAP ROOM, LIVING ROOM, SUN ROOM, BATHROOM IN HALL, ALL BEDROOMS, AND YARD AREA
OFF LIMIT AREAS: KITCHEN, AND CONVERTED GARAGE.

There are no pools, spas, or similar bodies of water on the premises. Per Licensee, there are no firearms or other dangerous weapons on site. Storage areas for poisons are inaccessible. Detergents and other cleaning compounds that can pose a danger to children are stored where inaccessible. A fully charged 3A40BC fire extinguisher, carbon and monoxide detectors were observed to be operable. The home is kept clean, and orderly with ventilation for safety and comfort. LPA observed safe toys, play equipment and materials. The home has a working telephone on site. Outdoor play areas are fenced and supervision is provided while children are outside. On today's date, Licensee was within the proper capacity for their large family child care home license. Licensee stated if a child in care falls ill, the living room will serve as an isolation area until parents are able to pick their child up. All individuals present during today's date had the proper criminal record clearance. Each child's filed contained the appropriate emergency information card.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: ZHANG, WEI
FACILITY NUMBER: 013419949
VISIT DATE: 07/22/2021
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Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

Individual Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. When any changes to the IMS plan is made, an updated Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies are being cited during today's visit. An exit interview was conducted. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. This report must be available for public review for 3 years. LPA provided Notice of Site visit and Licensee posted visit notice in LPAs presence. Notice of Site Visit must remain posted for the next 30 days.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
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