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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700453
Report Date: 04/26/2023
Date Signed: 04/26/2023 09:53:45 AM

Document Has Been Signed on 04/26/2023 09:53 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WU, GUIZHENFACILITY NUMBER:
015700453
ADMINISTRATOR:GUIZHEN WUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 876-7513
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Guizhen WuTIME COMPLETED:
10:05 AM
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On April 26, 2023 License Program Analyst (LPA) Lorraine Dacanay Breaux conducted a Case management/Other visit to inspect the rear/side yard. Licensee needed a lock for the hot tub. The purpose of today's visit is to add the rear/side yard from Off limits to On Limits. As of today's visit the hot tub has the correct lock that meets the requirements. Present during today's inspection is licensee, Guizhen Wu and daughter Michelle Huang for translation purposes.

ON LIMIT AREAS: Living Room, dining-room, half bathroom first floor, and Bedroom on the main level. Isolation Area: Bedroom away from the children in care, until parents pick up.

OFF-LIMIT AREAS: Entire 2nd level consisting of master bedroom and bathroom, 1 bedroom, bathroom and two car garage. These areas will be off-limits by safety gates, closed locked doors and visual supervision.

OUTDOOR SPACE: LPA toured the outdoor area (backyard). The yard is fully fenced. LPA observed hot tubs that is covered and locked. The licensee had a child's safety gate surrounding the play around for the children in care. LPA reminded licensee that 100% supervision is required when the children are playing in the rear yard.


There were no deficiencies cited during the visit. Notice of site visit provided. Appeal Rights provided. Exit interview conducted with licensee, Guizhen Wu.

NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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