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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701247
Report Date: 06/09/2025
Date Signed: 06/09/2025 02:57:21 PM

Document Has Been Signed on 06/09/2025 02:57 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LI, HONGJUNFACILITY NUMBER:
015701247
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
06/09/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Hongjun LiTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 6/9/2025 at 1:30PM, Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Hongjun Li for an Unannounced Licensee Initiated Case Management Visit. Licensee requested increasing capacity from 8 children to 14 children. Present during the inspection was the Licensee, 1 infant, 1 preschool aged child, and her fingerprint cleared husband. Licensee’s home was toured for a health and safety inspection. The facilities hours of operations are 6:00AM - 7:00PM, Monday - Saturday.

ON LIMITS AREA: Living Room, Family Room, Kitchen, Dining Area, Bathroom #1 (next to Family Room), and Backyard

OFF LIMITS AREA: All 3 Bedrooms, Hallway Bathroom, and Garage

ISOLATION AREA: Living Room

The facility is a 3 bedroom and 2 bathroom house owned by the Licensee. The inside of the home is observed to have age appropriate materials for the children. During today's visit all toxins, cleaning products, medications and hazardous materials were observed to be in inaccessible areas. All off limit areas in the home are made inaccessible with closed doors, safety gates, and locks. LPA did not observe any harmful bodies of water in or around the home. Licensee stated she has no pet and there are no firearms in the home. During the tour LPA observed 1 infant sleeping with 2 blankets and pad underneath them. LPA let Licensee know that nothing can be in the crib with the infant besides the fitted sheet.

The home has gained a fire clearance on 6/2/2025 from the Hayward Fire Department with the condition of the garage not to be used for childcare.



Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Jaleesa Jackson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/09/2025 02:57 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 06/09/2025 at 02:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LI, HONGJUN
FACILITY NUMBER: 015701247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2025
Section Cited
CCR
102425(b)

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Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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Licensee will review the infant safe sleep webinar on https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/resources-for-providers/webinars. Licensee will submit a signed statement of understanding after review of the video by POC date 6/23/2025.
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Based on observation, the licensee did not comply with the section cited above in 1 infant was sleeping in the crib with loose articles which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Jason Jang
NAME OF LICENSING PROGRAM MANAGER:
Jaleesa Jackson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, HONGJUN
FACILITY NUMBER: 015701247
VISIT DATE: 06/09/2025
NARRATIVE
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The home has a fully charged 2A10BC fire extinguisher in the home. There is a working carbon monoxide detector and smoke alarm in the home. The home is equipped with heat and air for proper ventilation. The Licensee’s Health and Safety training with the lead poisoning component has been completed and Pediatric CPR and First Aid certificates are current and expires on 10/2025. Mandated Reporter training is complete and expires on 12/2026.

All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

There was 1 deficiency cited on today's visit. See 809-D for deficiency.

Increase of capacity has been approved 6/9/2025.


A notice of site visit was given and must remain posted for 30 days.

Appeal rights provided and discussed.

Exit interview conducted and report was reviewed with Licensee Hongjun Li.
NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Jaleesa Jackson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC809 (FAS) - (06/04)
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