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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700498
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:21:57 PM

Document Has Been Signed on 09/13/2023 03:21 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LU, HEFACILITY NUMBER:
015700498
ADMINISTRATOR:LU, HEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 887-5809
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Applicant He, LuTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jyoti Saini conducted an unannounced Case Management visit (Prelicensing continuation). LPA Saini Met the applicant, Lu He. During today’s inspection, LPA did not observe any children in care except the applicant’s (11-year-old son).The applicant has posted the required postings. The hours of operations will be Monday to Friday 8:30am- 6:00pm.

ON LIMIT AREAS are family room (main day care), bathroom #1 (downstairs), dining area, fenced area of the backyard and living room (walk through to the backyard only)

OFF LIMIT AREAS: entire second floor, laundry room(downstairs) living room, kitchen, and garage.

Large Family Child Care License is recommended effective today (9/13/2023)

Exit interview conducted and report was reviewed with the applicant, Lu He.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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