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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020766
Report Date: 12/21/2022
Date Signed: 12/21/2022 04:23:58 PM

Document Has Been Signed on 12/21/2022 04:23 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 CAREFACILITY NUMBER:
198020766
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 11CENSUS: 6DATE:
12/21/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Feng Xiu ZhouTIME COMPLETED:
04:30 PM
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On December 21, 2022 at 1:30 pm, Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management - licensee initiated inspection. A COVID-19 risk assessment was conducted prior to entering the facility. The home is currently licensed for 8 children and a request for a capacity of 14 children was received. All areas identified on the facility sketch were toured. Hours of operation are Monday through Saturday 8:30am to 6:00pm. Licensee's English is limited, speaks Mandarin/Cantonese and her son translated.

The facility has requested an increase of capacity from 8 to 14 on 08/09/2022. Fire clearance was granted on 10/20/2022. Capacity Increase will be granted, pending final file review. License will be amended to reflect new capacity of fourteen (14) children. Increase is contingent upon a Licensing Program Manager review and approval.

The day care area is provided in 2 living rooms, one located near the entry way of the door and the other in the lower area near the back door, (1) bathroom and back yard.

The LPA inspected the facility and found the facility to be clean and safe. Telephone service was verified and additional phone number is being added per the application. Heating, lighting, and ventilation are adequate. LPA observed age appropriate toys and materials. LPA check fire extinguisher, which was last serviced on 4/18/2022. Both smoke detector and carbon monoxide were checked and found to be working adequately. Per Licensee there are no weapons, or pets on the premises. LPA inventoried First Aid box and found that scissors, tweezers and first aid guide was missing. Licensee will be purchasing and providing LPA proof with a receipt and photos of those items via email.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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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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: 12/21/2022
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LPA noted that Fire Drill Log is being conducted every month, as of December 2022, as well as CPR/First Aid expires 8/4/2023. Safe Sleep log is being maintained for infants 24 months and younger. Licensee has stated that spouse will be assisting her when capacity increases and LPA informed her of immunization's (MMR, Tdap and flu or flu waiver) needed when working directly with the children, as well as Mandated Reporting Training Certificate if available in Mandarin language. LPA obtained email address to register so Licensee will receive PINs.

LPA reviewed infant safe sleep regulation and ratios with licensee and provided a copy of the Title 22 Regulations 102352(i)(1) definitions was provided. A copy of the Safe Sleep Regulation (102425) was provided to the licensee along with LIC9227. LPA provided recall website, https://www.cpsc.gov/Recalls

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview was conducted, a copy of this report along, appeal rights with Notice of Site Visit was provided to the licensee.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
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