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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002633
Report Date: 05/03/2019
Date Signed: 05/03/2019 03:47:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ZHENG, SHI YINGFACILITY NUMBER:
384002633
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
05/03/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Shi Ying ZhenyTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection. LPA met with the licensee, Shi Ying Zheng, and licensee's husband. The purpose of the inspection was explained to her. There were 6 children that included 1 infant present. The licensee submitted an application for Large Family Child Care Home on 4/10/2019. LPA inspected the facility for health and safety hazard. The daycare area was clean and in order. All toxin and harmful were locked or made inaccessible to children. Temperature and lighting were adequate. Day-care areas are the entire downstairs including an in-law and backyard. The off-limits areas are the entire upper level, bedroom in the front, kitchen area, and a bathroom by the main entrance on the lower level. There were plenty of age-appropriate toys, books, learning material, and children furniture available for children. All sharp corners were covered. Childproof knobs were installed to all the doors. The carpet was installed to the entire floor as the soft cushioning to prevent injury. Gate was used at the main entrance to prevent children access to the off-limits. Children's bathroom was clean and free of the harmful object. Per licensee, Fire Marshal inspected the daycare area already, Some corrections have to be completed to meet the fire requirement before approval. The corrections are located in the backyard. Licensee has been working on it. Per licensee, she will contact the Fire Marshal for the final inspection in the near future since the corrections will be completed soon.

The following item has to be received by CCL prior licensure:

Fire Clearance Approval


This report was reviewed and provided to the licensee. The notice of Site Visit was given as well.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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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