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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700316
Report Date: 08/05/2022
Date Signed: 08/05/2022 10:47:40 AM

Document Has Been Signed on 08/05/2022 10:47 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LIEN, SHUANGFACILITY NUMBER:
015700316
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Shuang "Connie" LienTIME COMPLETED:
11:00 AM
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On 8/5/2022 Licensing Program Analyst (LPA) Jaylena Miller met with licensee Shuang "Connie" Lien for an announced CASE MANAGEMENT inspection for an INCREASE OF CAPACITY to a large family childcare home. Today is a staff development day and the facility is closed, there are no staff or children present except licensee.

The fire clearance for the increase of capacity was received and approved on 8/04/2022.

LPA toured the entire home and backyard for a health and safety inspection. The home has an acceptable amount of space, number of toys and furnishings that are neat, clean and age appropriate. The home is equipped with a 2A-10-BC fire extinguisher, working smoke detector, and working carbon monoxide detector. There is a working telephone in the home. Per licensee there are no firearms on the premises. There are no pools, hot tubs, or other bodies of water present at the time of the inspection. All poisons, cleaning solutions and medications are inaccessible to children.

Licensee has received certificates of completion in Preventative Health and Safety training on 10/17/2021, the mandated reporter training on 10/19/2021, and CPR and First Aid which is current and expires on 11/12/2023. LPA Miller reminded licensee that CPR/First Aid and Mandated Reporter Training must be renewed every two years and CPR/First Aid needs to be EMSA approved.

This home is recommended for a large family child care home license as of 8/05/2022. There are no deficiencies cited. This report shall remain on file for 3 years. Notice of site visit given and exit interview conducted with Licensee and a copy of this report was provided.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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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