304312921-10-18-2019-06-CC-GCOY-BH3MJZ-20191018093957

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312921
Report Date: 10/18/2019
Date Signed: 10/18/2019 09:40:18 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ZHANG, MINGQIONG & ZHANG, HANJIE		FACILITY NUMBER:	304312921
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	10/18/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Mingqiong Zhang and Hanjie Zhang		TIME COMPLETED:	10:00 AM

NARRATIVE

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A case management inspection is made today due to a change in capacity application received in the licensing office 10/10/19. Present today were co licensees Mingqiong and Hanjie Zhang as well as 6 children in care two of whom infants. Children were awake and actively engaged in the activities of the day care.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances.

The facility, clean and in good repair, was toured inside and out. Toys that appear age appropriate for ages served are in the living and dining areas redesigned as a play room. Latches in place in the kitchen and bathroom appear in good working order. The fire extinguisher, smoke detector and carbon monoxide detector are within regulation. There is no fire place. Pediatric CPR and First Aid cards for both licensees are current until 2021. A gate installed at the base of the stairs leading to the second story of the home was in place.

The fenced backyard serves as the outdoor play area for children in care.

Children files were reviewed. Employee file was reviewed as well. Files are maintained and complete. Fire clearance will be ordered. Payment received for increase in capacity.

Licensees have provided copies of proof of immunity for Measles and Pertussis as well as documentation regarding precaution to influenza. Licenses have also provided certificates of successfully completing mandated reporter training.

Continued on page two

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZHANG, MINGQIONG & ZHANG, HANJIE	FACILITY NUMBER: 304312921
	VISIT DATE: 10/18/2019

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Licenses were reminded:
1.) Always place infants on their backs for sleeping.
2.) Use only a tight fitting sheet on the crib or play yard mattress.
3.) Do not hang any items from the crib or above the crib.
4.) Keep all items, including blankets, out of the crib or play yard.
5.) Pacifiers may be used as long as they do not have items attached to them.
6.) Infants should not be swaddled or have any items covering them while sleeping.
7.) The temperature of the room should be comfortable enough for an adult to wear a t-shirt or not be too hot or too cold.

LPA provided a Community Care Licensing Division Quarterly Update.

In the areas that were evaluated no deficiencies were observed of the California Code of Regulation, Title 22, and Division 12 at the time of the inspection.

An exit interview was completed with license Hanjie Zhang. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

LIC809 (FAS) - (06/04)

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