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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500802
Report Date: 06/26/2023
Date Signed: 06/26/2023 07:13:58 PM

Document Has Been Signed on 06/26/2023 07:13 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:XIONG, DANFACILITY NUMBER:
344500802
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
06/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Dan XiongTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Corina Beckby met with Licensee, Dan Xiong on 06/26/2023 for the purpose of an unannounced plan of correction inspection to clear a Type A deficiency, which was issued on 06/16/2023 for being over ratio.

There were 6 children including 1 toddler during today's inspection. LPA toured the facility and found no deficiency. Licensee has disenrolled 1 family and adjusted part time schedules for the remaining families to comply with regulations. Licensee produced a visual schedule to manage full time and part time families. Licensee also wrote a statement acknowledging she understands her maximum capacity.



Deficiency cited on 06/16/2023 is cleared effective today, 6/26/2023. Proof of correction letter was provided. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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