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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500802
Report Date: 10/31/2023
Date Signed: 10/31/2023 11:58:21 AM

Document Has Been Signed on 10/31/2023 11:58 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 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: DATE:
10/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Dan XiongTIME COMPLETED:
12:45 PM
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On October 31, 2023, Licensing Program Analyst's (LPA's) Corina Beckby and Stacey Willams met with Licensee, Dan Xiong for the purpose of conducting a case management inspection. LPA's observed Licensee and parents caring for 6 day care children including 2 infants.

LPA toured the On Limit areas of the home during the inspection. Licensee informed LPA's that the backyard is currently under repair. License has recently removed and dismantled a trampoline that she felt was unsafe. Licensee reported that she will be making renovations to the backyard to accommodate a safe environment for children in care and is requesting backyard to be off limits at this time. LPA's advised Licensee to notify LPA Beckby when the backyard is complete and ready for use before allowing children enter the off limit area.

As of today, the OFF-limits areas of the FCCH are the pantry, laundry room, entire second floor, the entire backyard, front yard, and garage.

An Exit interview was conducted, and the report was reviewed with Licensee, Dan Xiong. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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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