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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412832
Report Date: 03/12/2024
Date Signed: 03/12/2024 10:26:05 AM


Document Has Been Signed on 03/12/2024 10:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 6DATE:
03/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Guifen, ZhangTIME COMPLETED:
10:35 AM
NARRATIVE
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On 3/12/2024, at 9:10 AM, Licensing program analyst (LPA), Doni Fici conducted an unannounced plan of correction (POC) visit, and was greeted by licensee, Guifen, Zhand, and explained the purpose of visit. LPA observed six (6) children, and two (2) staff members during visit. LPA observed the facility roster for children, which is current.

The purpose of the POC visit is to verify corrections of the deficiencies that were previously cited on 2/28/2024.

**The facility purchased a new fire extinguisher and replace the old one and a copy of the receipt was observed. LPA observed that all deficiencies were corrected and have been cleared during today’s visit.

A NOTICE OF SITE VISIT WAS ISSUED TODAY AND MUST REMAIN POSTED ALONG WITH PROOF OF CORRECTED DEFICIENCIES FOR 30 days.

No deficiencies cited during visit.


Exit interview conducted with Licensee, and a copy of this report reviewed and provided.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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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