198020766-7-14-2021-33-CC-AGOK-C4WTU5-20210714150148

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020766
Report Date: 07/14/2021
Date Signed: 07/14/2021 03:01:51 PM

Document Has Been Signed on 07/14/2021 03:01 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:	ZHOU FAMILY CHILD CARE		FACILITY NUMBER:	198020766
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	07/14/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Feng Zhou		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An announced prelicensing follow-up visit was conducted by Licensing Program Analyst (LPA) Alanna Gontarek. LPA met with Feng Zhou, applicant. Applicant’s son translated this report to the applicant, into Cantonese. The follow-up visit is to ensure the following items have been corrected: Applicant placed a latch over front closet (3 drawers) in living room. Applicant removed refrigerator and T.V. in living room. Applicant latched hallway cabinet drawers Applicant removed router and modem in hallway and place on flat surface. Applicant placed door covers over front safety gate door knob and all three bedroom door knobs. Applicant placed latch over outdoor sink cabinet doors. Applicant installed 5-foot tall barrier/gate between side yard and outdoor play area. Applicant removed wood and concrete pieces near fence by side yard. Applicant barricaded 3 AC units, located in backyard, and removed one AC unit in Daycare room, sealing window opening. Applicant removed loose hose in back yard Applicant removed metal stump on ground in backyard. Applicant secure loose cord on wall of home in backyard. Applicant barricaded opening of front entry gate (7 inch wide gap at end of fence) with a metal piece. Applicant posted the required forms on a Parent Board. LPA reviewed Licensing forms with applicant. Applicant's son translated into Cantonese. LPA provided Licensing forms in Chinese to applicant: Chinese Additional Children in Care(LIC 9150), Child Abuse

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ZHOU FAMILY CHILD CARE	FACILITY NUMBER: 198020766
	VISIT DATE: 07/14/2021

NARRATIVE

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Acknowledgement (SOC 341A), Chinese Health History (LIC 702), Chinese Lead poisoning (PUB 515), Never shake a baby (PUB 271), Parent Rights (PUB394CH), Parent Rights Poster (LIC995E_CH),
Parent Rights Notification (LIC 995CH), Personal Rights (LIC 613ACH), Sleeping Plan (LIC 9227), Suspected Child Abuse Acknowledgement (LIC 9108 CH), Type A Acknowledgment (LIC 9224CH), Earthquake Preparedness (LIC 9148(CH)), Emergency Plan (LIC 610BCH), Notification of Parent Rights (LIC 995A_CH.), and Unusual Incident Report (LIC 624B CH).

LPA observed all have been corrected and the home is currently in compliance with Title 22 State regulations. Recommendation for a small family child care license will be made.

Once your home is licensed for a family childcare, all future visits are unannounced.
--Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
--Child Care Licensing website address: http://www.ccld.ca.gov – To access: licensing forms, updates, Provider Information Notices (PINs), and Title 22.

Exit interview conducted with Feng Zhou, applicant. Applicant’s son translated this report (LIC 809) and Appeal Rights to applicant in Cantonese. This report and Appeal Rights were provided to the applicant.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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