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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004309
Report Date: 08/05/2020
Date Signed: 08/05/2020 04:13:04 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:CHEN, TIANYANFACILITY NUMBER:
384004309
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/05/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tian Yan Chen (Ada)TIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA) Mok conducted an announced tele inspection with a licensee, Tian Yan Chen (Ada) via FaceTime to complete the follow-up Prelicensing inspection. Licensee applied for location change on 7/24/20. The license number for the current location is #384004076. Licensee rents an unit on the ground floor. The unit is located in the building with 3 separate units. There are separate entrance for each unit. Licensee rents an unit with 2 bedrooms, 1 bathroom, living area, dining area, kitchen, and laundry area. The daycare areas are bedroom #1 (room by the main entrance), bathroom, living area, dining area, and kitchen. The off-limit areas are Storage room (by the main entrance), bedroom #2 (Licensee's room), laundry area, and backyard. LPA toured the facility for health and safety hazards. There was a window with window lock in bedroom #1. Licensee also installed the latches to the sliding closet doors in the room. All electrical outlets were covered. Child proof knobs were installed to the doors at main entrance, bedroom#2, and Storage room by the main entrance. Licensee also installed the door guard to the bathroom and bedroom #1 doors to prevent injury. All sharp corners were covered. Gate was installed at the entrance of the laundry room. Children's bathroom was clean. The lower bathroom cabinet was latched. The lower kitchen drawers and cabinets were free of harmful objects. All sharp and harmful objects were made inaccessible to the children in the kitchen area. Mats and play pens are used as the napping equipment. There was a book shelve that was mounted to the wall in the living area. There were plenty of the age appropriate toys, books and children 's furniture available to the children. There were a fully charged 2A10BC fire extinguisher, working 2 in 1 smoke and carbon monoxide detector available in the house. Licensee also has a touchless Thermometer available in the house. As of today, LPA approved and licensed this location.



This report was provided to the licensee via e-mail. The licensee needs to send a copy of the report with her signature back to LPA either via e-mail or mail.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020
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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