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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004182
Report Date: 09/20/2019
Date Signed: 09/20/2019 03:43:19 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:NG,CINDY YUE ZHENFACILITY NUMBER:
384004182
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
09/20/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Cindy NgTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Mok conducted an announced a prelicensing inspection today. LPA met with the licensee, Cindy Zhen. Licensee submitted an application for location change on 9/5/19. Facility is originally licensed with facility number #384002228. The new location is owned by the licensee. Licensee lives in the house with her husband, her 2 daughters, and a son. The house has 3 bedrooms, 1 bath, living room, open kitchen on the upper level and the lower has 1 bathroom, 2 bedrooms, living room, garage and a backyard. The daycare areas are the entire lower level except garage and backyard. The Off Limit areas are the entire upper level, garage and backyard. LPA toured and inspected the facility for health and safety hazard. The house was clean and in order. Temperature and lighting were adequate. All toxins and harmful object were either locked and made inaccessible to the children. There were a fully charged extinguisher, working cellular phone, working smoke and carbon monoxide detectors, and first aid supplies available in the daycare. Gate was installed at the stairway to the upper level. Child proof knobs were installed to the door to the garage. All electrical outlets have built-in blockage to prevent children access. Facility provides breakfast AM/PM snacks, lunch, and dinner. The lower bathroom cabinet was free of harmful object. Per licensee, she will submit an application for capacity increase in the near future.

The following items have to be completed prior licensure:

· Proof of 8 hrs Preventative Health and safety Training.

· Picture of the daycare areas with all the equipment and toys, and all the rooms on the upper level after licensee completely move in.

· First Aid kit

· Child proof knobs to the doors of daycare main entrance and the door to backyard.

This report was reviewed and explained to licensee.

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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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