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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423682
Report Date: 05/24/2022
Date Signed: 05/24/2022 03:28:47 PM

Document Has Been Signed on 05/24/2022 03:28 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:WEN, CHUNRUFACILITY NUMBER:
013423682
ADMINISTRATOR:WEN, CHUNRUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 813-8891
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
05/24/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Chunru WenTIME COMPLETED:
02:45 PM
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On 05/24/2022 LPA Singh met with Licensee for a Case Management Visit. Licensee would like to add her kitchen to the On limit areas of the home. LPA has inspected the kitchen area and has found it to be in compliance for children to use.


IN USE AREAS: The living room, bedroom #1 (classroom) located in the hallway area, the bathroom #1 located across from kitchen, kitchen and the backyard.

OFF LIMIT AREAS: Bedroom #2 located on the left side of living room, bathroom #2 located near bedroom #2, and garages.

LPA has read this report with Licensee and has been signed. Exit interview was conducted and notice of site was issue which must remain posted for 30 days.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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