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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002997
Report Date: 11/15/2019
Date Signed: 11/15/2019 10:20:31 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:CAO-READ, JINGFACILITY NUMBER:
414002997
ADMINISTRATOR:CAO-READ, JINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 336-5732
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:14CENSUS: 6DATE:
11/15/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH: Cao -Read ,JingTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Saini met with Licensee Cao-Read Jing, for an inspection of plan of correction. Purpose of the inspection was explained. Present, there are 6 children in the care. Facility is operating within the capacity.

During previous inspection on 11/6/19 facility received the citation for not having..
  • Licensee's helper's Immunization record in the file.
  • Child's record was not complete.
  • Facility roster was not complete.

During today's inspection,
  • LPA observed facility has Licensee's helper Immunization record in the file. During the visit, copy of the immunization record is obtained.
  • Child's file is updated.
  • Facility roster is complete and updated. During the visit, Copy of the Roster is obtained.

Previous citation has been cleared.

No deficiencies are cited today. Copy of this report is reviewed and provided to the Licensee.. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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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