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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004332
Report Date: 12/01/2021
Date Signed: 12/01/2021 12:15:30 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: 2DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Li Xing LiuTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, Li Xing Liu. LPA explained the purpose of the inspection to her. There were 2 children present. The licensee owns the 2 story single family house that has 2 bedrooms, 1 and half bathroom, kitchen, dining room and living room on the upper level; garage and backyard on the lower level. The licensee lives in the house with her husband and her son, The daycare areas are living room, dining room, bathroom, and first half of the kitchen that next ot the dining room. The off-limit areas are bedroom #1 and #2, the entire lower level, and backyard. LPA inspected the facility for health and safety hazards, Temperature and lighting were adequate. The facility was clean and in order. There were plenty of the age-appropriate toys, books, learning material, and children's furniture available for the children. There were a fully charged 2A10BC fire extinguisher, working cellular phone, and first aid supplies available. All electrical outlets had internal blockage. Fireplace was blocked. Gates were installed at the entrances of the living room, between kitchen and dining room, and second half of the kitchen to prevent children's access. The windows in the living room and dining room had locks to limit the window to be opened up to 4 inches. The licensee installed soft cushioning to the floor to prevent injury in the daycare area, The children's bathroom was clean and in order. LPA didn't observe any harmful object in it. The licensee provides PM snacks, lunch, and dinner to the daycare children. Mats were available for napping. Couple of boosters were available for feeding only. The licensee conducts the fire drill with the children every 6 months and logged. The licensee had current CPR/First aid training. It will expire in 3/2023_. The licensee had current Child Abuse Mandated Reporter Training as well. It will expire in 4/2023. The licensee also had hand sanitizer, disinfectant, and thermometer available for screening when the children arrive to prevent COVID 19. Per licensee, there were no children on special medication. LPA reviewed the children's files and obtained a copy of the children roster from the licensee during the inspection.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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