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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700018
Report Date: 12/04/2020
Date Signed: 12/04/2020 03:35:15 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:ZHOU, YIRU & LU, HEFACILITY NUMBER:
015700018
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
12/04/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:He Lu & Yiru ZhouTIME COMPLETED:
12:00 PM
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DUE TO COVID-19 PANDEMIC THIS TELE-VISIT IS BEING CONDUCTED BY FACETIME.

On 12/4/2020 at approximately 10:30 AM, Licensing Program Analyst (LPA), Renee Reed , met with Licensees Yiru Zhou and He Lu for an Announced Case Management Change of Capacity (Increase) Inspection via FACETIME. Present for this inspection was 5 preschoolers and 1 infant. .

The home was toured to conduct a Health and Safety Inspection. The home remains the same as the last inspection on 9/6/2019.
The OFF LIMIT AREAS are the nook area to the right of the entry way, garage, laundry room, 2 bedrooms, master bathroom, and kitchen which will be inaccessible by closed and/or locked doors, child barricades, and visual supervision.
The ON LIMIT AREAS are the living/dining room (child care area), backyard, and hallway bathroom.
The ISOLATION AREA will be in the dining room. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of toys and activities available for children, and they are in good condition and age appropriate. There is a hot tub that is located in the back right corner of the backyard and is surrounded by an additional gate. The hot tub is fully covered and latched to prevent access to children. 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.

Smoke detectors and carbon monoxide detectors were tested and in good working order. A pull down fire alarm and a fully charged fire extinguisher with a 2A10BC was present.

Fire Clearance was granted by the Dublin Fire Prevention Services on 11/16/2020, noting (GARAGE OFF LIMITS TO CHILDREN).
See 809-C
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee ReedTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020
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: ZHOU, YIRU & LU, HE
FACILITY NUMBER: 015700018
VISIT DATE: 12/04/2020
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LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. LPA discussed Unusual Incident Reports.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

There are no deficiencies cited today. This report shall remain on file for 3 years. Notice of Site visit was emailed to the licensee to be posted for the next 30 days. Exit interview was conducted.

Based on the approval of the fire clearance, issuance of license is recommended for this home effective today 12/4/2020.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee ReedTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020
LIC809 (FAS) - (06/04)
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