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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004309
Report Date: 08/25/2021
Date Signed: 08/25/2021 11:32:59 AM

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: 6DATE:
08/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tianyan Chen (Ada)TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Mok, conducted an unannounced case management inspection for the capacity increase today. LPA met with the licensee, Tianyan Chen (Ada), and her helper (mother -in-law) who has fingerprint clearance. The purpose of the inspection was explained to her. All adults are fingerprinted. The licensee applied for capacity increase from small to Large family child care on 8/16/2021. There were 6 children included 3 infants with a helper present. The licensee rents an unit on the lower level with 2 bedrooms, a bathroom, a kitchen with an adjacent dining area, living room, and a backyard. The licensee lives in the unit with her husband. LPA toured the facility for health and safety hazards. The daycare areas are the entire unit and backyard except bedroom #2, The fire clearance was received by CCL and kept in file. The facility was approved for Large Family Child Care license as of today.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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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