<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422937
Report Date: 01/17/2023
Date Signed: 01/17/2023 10:26:26 AM


Document Has Been Signed on 01/17/2023 10:26 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:FENG, DEMINFACILITY NUMBER:
013422937
ADMINISTRATOR:FENG, DEMINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 862-5974
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:14CENSUS: 6DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Demin FengTIME COMPLETED:
10:38 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Sidney Cortez, met with licensee DEMIN FENG for. UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee DEMIN FENG, her fingerprinted assistant Dehui Feng and 6 preschool age age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:30AM until 6:00 PM, MONDAY-FRIDAY.The home is a one level, which consists of two bedrooms, a room within the garage, two bathrooms, living room, dining room, backyard, and garage, which are neat and clean, with heating and ventilation for safety and comfort.
ON LIMIT AREAS: The living room, study room, one bathroom, dining room, kitchen, and backyard.
OFF LIMIT AREAS: The two bedrooms, one bathroom, the room situated within the garage, andthe garage.
The ISOLATION AREA will be the study area section–the one in the corner
There are ample age appropriate toys that are safe and appeared to be clean. There are no pools, hot tubs or any other bodies of water on the premises. 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.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone.
The licensee's Health and Safety training is completed and CPR and First Aid certificates are current and expires OCT 2023. The applicant is in compliance with new immunization laws which pertain to day care providers. Per applicant, there are no firearms in the home. A copy of the mortgage statement was reviewed and shows control of property. The licensee's mandated reporter training is current and expires (FEB,2024).
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 NOVEMBER 22, 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: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 3