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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004382
Report Date: 04/22/2022
Date Signed: 04/22/2022 01:11:21 PM


Document Has Been Signed on 04/22/2022 01:11 PM - It Cannot Be Edited

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:ZHEN, JIANCIFACILITY NUMBER:
384004382
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
04/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jianci ZhenTIME COMPLETED:
01:00 PM
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On April 22, 2022 at approximately 12:00pm, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Case Management Visit for an increase of capacity from a small family child care to large family child care. LPA met with Licensee Jianci Zhen. Purpose of visit was explained. Present during the visit were Licensee and assistant caring for 3 infants and 2 preschool.

Fire Clearance have been granted by the San Francisco Fire Department on 04/05/2022.

LPA inspected the entire home for health and safety hazards. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of age appropriate toys that were in good condition. Outdoor area is equipped with age appropriate toys and materials that were also in good working condition. There were no pools, spas or bodies of water on the property. All cleaning supplies, poisons, other chemicals, and sharp objects were stored inaccessible to children behind child safety locked cabinets and drawers. Accessible electrical outlets have child safety covers and/or are blocked by furniture.

A large license has been granted and effective on this date.

This report was reviewed and discussed with Licensee. A copy of this report will be emailed to licensee. Notice of Site visit will also be emailed to licensee. Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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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