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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700494
Report Date: 09/27/2023
Date Signed: 09/27/2023 12:35:10 PM

Document Has Been Signed on 09/27/2023 12:35 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:LI, HUANYINFACILITY NUMBER:
015700494
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Huanyin LiTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on today's date, 9/27/2023 at 12:05PM, to conduct a Case Management inspection for an INCREASE IN CAPACITY. LPA was met by Licensee Huanyin Li. Also present during today's visit was a fingerprint cleared staff member and 6 children (2 infants and 4 preschoolers).

LPA conducted a health and safety inspection of the facility. The ON LIMITS areas are: the dining room, living room, guest bedroom, bathroom across from guest room and right side of back yard. The OFF LIMITS areas are: Two bedrooms at the back of the house, left side of the yard, garage and kitchen. On this date, the facility is within the capacity specified on the license. The home is kept clean, safe, sanitary and in good repair. The Licensee has a current children's roster. LPA inspected and verified that the fire extinguisher, 2A10BC is fully charged, smoke detector, carbon monoxide detector and home phone are in working condition. Outdoor play area is fenced and supervised by the Licensee.

The fire clearance for the increase in capacity was received and approved on 8/31/2023.

No deficiencies are being cited. This home is recommended for the capacity increase as of today's date. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. This report shall remain on file for 3 years. Exit interview conducted with licensee. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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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