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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019333
Report Date: 08/23/2022
Date Signed: 08/23/2022 02:20:27 PM

Document Has Been Signed on 08/23/2022 02:20 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HE FAMILY CHILD CAREFACILITY NUMBER:
198019333
ADMINISTRATOR:XIUMING HEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 688-8285
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 14TOTAL ENROLLED CHILDREN: 1CENSUS: 0DATE:
08/23/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Xiuming He - LicenseeTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) conducted an unannounced visit to follow up on the Proof of Correction from the previous Annual inspection dated 8/2/22.

Correction:
1) Licensee will either locate the proof of current Mandated Reporter training and submit to LPA by POC due date or will take the Mandated Reproter training and submit the proof of completion to LPA by POC due date of 8/23/22.

LPA spoke with Licensee at the facility and Licensee clarified that she was Mandarin-only and had limited understanding of English. LPA cleared the POC and provided a copy of the Cleared POC letter.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Tung
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
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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