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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423866
Report Date: 04/10/2023
Date Signed: 04/10/2023 01:02:10 PM

Document Has Been Signed on 04/10/2023 01:02 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HAO, JIAFACILITY NUMBER:
013423866
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/10/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jia HaoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Cherie Acosta met with applicant Jia Hao for an announced Prelicensing Inspection. Present during the inspection was the applicant and her fingerprint cleared husband Simon Zhong.

The home was toured for a Health and Safety Inspection. This address and 907 60th St., Oakland are both owned by the applicant. The two addresses share a common door that leads to separate entrance doors. The applicant and her husband are currently residing in the home address of 907 60th St., Oakland with the intent of operating a family child care home in the 905 60th St., Oakland address. LPA toured both addresses. The homes also share a common yard.
There are no pools, hot tubs or any other similar bodies of water at this home. There are no firearms in the home as stated by the applicant. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 3A40BC fire extinguisher.

A packet f forms pertaining to the children’s files and facility files were reviewed and discussed.
The applicant has current CPR/First Aid which expires 05/24. Applicant completed mandated reporter training 2/16/23. Applicant is in compliance with required immunizations.
A copy of the mortgage statement was reviewed and shows control of property for both 905 and 907 60th Street, Oakland. LPA advised applicant that as a requirement of licensure she must live in the home that is licensed as a Family Child Care Home. A license is not issued today as applicant is not currently living at 905 60th Street, Oakland, CA.

Report reviewed with Jia Hao.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2023
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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