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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421229
Report Date: 09/14/2022
Date Signed: 09/14/2022 12:22:08 PM


Document Has Been Signed on 09/14/2022 12:22 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:HUANG, SHIRLEYFACILITY NUMBER:
013421229
ADMINISTRATOR:HUANG, SHIRLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 520-8938
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:14CENSUS: DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
11:35 AM
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Licensing Program Analyst Sidney Cortez, met with licensee Shirley Huang for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee Shirly Huang and her assistant Sandra Zhao,. Present on this visit is 6 Preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:00AM until 530PM, MONDAY-FRIDAY. The home is two levels, which are neat and clean, with heating and ventilation for safety and comfort. The stairways had child safety gates in place. The home does have a backyard. The isolation area will be in the kitchen . There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection


ON LIMITS: The entirety of the first floor with the exception of the garage. The kitchen, living room, bathroom, and backyard. OFF LIMITS: The entirety of the second andThe garage.Licensee is using living room as isolation area:


There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.Per licensee, there are no firearms in the home.

The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit.The home has a fully charged (2A10BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (July 2023). The licensee's mandated reporter training is up to date and she took it Oct 2021 and will expire in 2 years. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on July 11, 2022.

2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney CortezTELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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