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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019921
Report Date: 07/29/2021
Date Signed: 07/29/2021 01:51:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WU & HE FAMILY CHILD CAREFACILITY NUMBER:
198019921
ADMINISTRATOR:ZHI WU & QINA HEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 592-7558
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91755
CAPACITY:14CENSUS: 9DATE:
07/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:Licensee, Qina HeTIME COMPLETED:
12:11 PM
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On July 29, 2021 at 11:54 a.m., Licensing Program Analyst (LPA) Mireya García, contacted Licensee, Qina He, via telephone due to COVID-19 and precautionary measures in order to conduct an unannounced Case management inspection to ensure that facility is in compliance. At 11:55 a.m., the call was transferred into a FaceTime tele-inspection. LPA García discussed the purpose of the call. During this tele-inspection the Licensee, Qina He took this LPA on a virtual tour of the facility. There were 9 children present, 4 being infants. Also present was Licensee husband Zhi Wu. During this Tele-inspection interpreting was provided by CTS Language link- Interactive Voice Response via telephone by translator Leo operator#12227 in the language of Cantonese. The following has been observed:

· LPA observed Licensees in compliance with children’s ratio.

At this time, the licensees are in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WU & HE FAMILY CHILD CARE
FACILITY NUMBER: 198019921
VISIT DATE: 07/29/2021
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Exit interview was conducted with Licensee, Qina He via tele-inspection, during which Appeal Rights were verbally explained to Licensee Qina He. A copy of this report has been signed by LPA García. This report, along with a copy of the Appeal Rights (LIC 9058) will be scanned via e-mail to Licensee, Qina He, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. The facility representative was provided with the mailing address to the Monterey Park Regional Office (1000 Corporate Center Drive, Suite 200B, Monterey Park, CA 91754) and agrees to send a copy of the signed LIC 809 reports by email to LPA and mail originals forms to the office.

END OF REPORT: PAGE 2 OF 2.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2