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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011574
Report Date: 10/12/2023
Date Signed: 10/12/2023 11:02:08 AM

Document Has Been Signed on 10/12/2023 11:02 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ZHANG FAMILY CHILD CAREFACILITY NUMBER:
198011574
ADMINISTRATOR:ZHANG, YANFENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 307-0595
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91755
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
10/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Yanfen Zhang TIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Roxana Lopez and Kruz Long conducted an unannounced case management- incident inspection today, due to an incident that occurred on 9/28/2023. LPAs met with Yanfen Zhang Licensee and Assistant Helen Zhang..Translation was provided by assistant Helen Zhang.

Incident was self reported via telephone same working day. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received via email on 09/29/2023. The facility reported the incident within the required 24 hour time frame.

LPA's observed the area where incident took place. LPA's conducted interviews with staff and children. Incident was observed by staff and required first aid was conducted. No disclosures were made by children.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with Licensee, Yanfen Zhang

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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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