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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004332
Report Date: 12/02/2020
Date Signed: 12/02/2020 02:43:40 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:LIU,LI XINGFACILITY NUMBER:
384004332
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/02/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Liu Li XingTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Mok conducted an announced Tele inspection with a licensee, Liu Li Xing, via FaceTime to complete the Prelicensing during Pandemic due to the licensee applied for a location change on 10/23/20. The Licensee owns the two stories single-family house with two bedrooms, one and a half bathroom, a living room, dining room, and kitchen on the upper level, a Garage, and a backyard on the lower level. The licensee lives in the house with her husband and son. All adults have fingerprint clearance. The Daycare areas are as follows: the living room, dining room, first half of the kitchen area & one and a half bathroom, Off-limit areas are all bedrooms, second half of the kitchen area (stove area), and entire lower level (Garage and backyard). LPA virtually toured the facility for health and safety hazards. There was a fully charged 2A10BC, working smoke and carbon monoxide detectors, and first aid supplies available. There were some appropriate toys, books, learning materials, and children's furniture available for children. All children's items were in good condition and repair. The licensee blocked the fireplace with a bookshelf. All windows in living and dining rooms had window locks to limit the windows to be opened up to 4 inches. All electrical outlets were TRR type- (it is with the spring-loaded receptacle cover) in the daycare areas. Gates were installed at the entrance of the living room, dining room from the hallway, and the second half of the kitchen area to prevent children's access to the off-limit areas. Childproof knobs were installed to the doors of the bedrooms, dining room, kitchen doors, and main entrance to prevent children's access to the off-limit areas. The licensee had the soft cushioning pads available in the house. The licensee will install it in the daycare areas to prevent injury later. The licensee latched all lower kitchen cabinets, and the lower drawers were no harmful objects in them. The children's bathroom was clean and free of dangerous items. Mats were available for napping. A couple of Boosters were available for feeding only in the kitchen area. The licensee also had the Thermometer, hand sanitizer, Clorox wipes, face masks, and gloves available in the house to prevent COVID19. LPA discussed the new Safe Sleep Regulations and COVID19 Technical Assistance with the licensee during the inspection. LPA licensed the new location as of today.

LPA provided this report to the licensee via e-mail. The licensee has to return a copy of the report with the signature to CCL via e-mail or mail as soon as possible.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
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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