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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500802
Report Date: 04/04/2023
Date Signed: 04/04/2023 08:53:16 AM

Document Has Been Signed on 04/04/2023 08:53 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:XIONG, DANFACILITY NUMBER:
344500802
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Dan XiongTIME COMPLETED:
09:00 AM
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On 4/4/2023 Licensing Program Analyst (LPA) Corina Beckby conducted a follow up prelicensing visit and met with applicant, Dan Xiong and interpreter/friend (via phone) Winnie Xiong.

The purpose of the inspection was to ensure all poisons and toxins are locked under lock and key. Poisons and toxins are stored in a cabinet with a key lock in the garage. Items stored in the downstairs bathroom have been removed from lower cabinet and are inaccessible to children. LPA walked the perimeter of the backyard and noticed the bag of potting soil was removed from the backyard. The broken glass in the backyard was removed and discarded. The door leading to the water heater and gardening tools has a door knob that locks from the inside and needs a key to open. All potential hazards have been removed.

Effective today 4/4/2023, the facility is licensed to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

Exit interview was conducted and report was reviewed with the Applicant, Dan Xiong.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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