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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412832
Report Date: 10/01/2021
Date Signed: 10/01/2021 09:13:05 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ZHANG, GUIFENFACILITY NUMBER:
434412832
ADMINISTRATOR:ZHANG, GUIFENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 218-4674
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:14CENSUS: 1DATE:
10/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Guifen ZhangTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Janette Cruz met with Guifen Zhang, Licensee conducted an unannounced follow-up case management inspection today to deliver a Required 1-Year amended report dated 09/09/21.

Licensee was issued a Type A deficiency for not obtaining Criminal Record and child abuse index clearance for her son when he turned 18 years old.

LPA observed LIC 9224 Acknowledgement of Receipt of Licensing Reports regarding Type A deficiency, signed by parents in each child's file.

LPA issued a POC clearance to clear the Type A deficiency during today visit.

An exit interview was conducted with the Licensee. No other deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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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