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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500802
Report Date: 11/21/2023
Date Signed: 11/22/2023 08:01:05 AM

Document Has Been Signed on 11/22/2023 08:01 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: 6DATE:
11/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Dan XiongTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Corina Beckby met with the Licensee, Dan Xiong, for the purpose of a case management inspection that was initiated by the Licensee. During today's inspection, Licensee and her parents were caring for 6 children preschool children including one infant.

Today's inspection was requested by Licensee to change the backyard from “off limit” area to “on limits”. Licensee called her friend “Ying” to help with translation. LPA toured the backyard with Licensee. The backyard has artificial grass laid throughout the backyard with a small concrete walkway. Licensee stated she pulled out the lemon tree because it has thorns. The backyard has 3 small slides and a small playhouse. Licensee is unsure of suggested age by manufacturer but believes for up to 3 years of age. LPA suggested Licensee purchase soft rubber mats and place them under the slide structures to soften a fall. Licensee stated she will look for the mats. Once the mats are purchased Licensee will send LPA pictures of the mats. LPA also suggested children no longer ride toys considering the exposed concrete area is small and the flooring under the artificial grass is concrete. Licensee stated she understands and will not allow push riding toys in the backyard. Licensee is responsible for supervision at all times when the children are outside.
As of today,11/21/23, LPA Beckby has approved the backyard to become "on-limits” area.

During the inspection, Licensee asked about the process for going Large. LPA reminded Licensee she needed to have at least 1 year experience with her license and suggested contacting LPA closer to her anniversary to begin the process for a change of capacity. LPA suggested parents get their required documents on file if she will consider them assistants. LPA printed out Entrance Checklist (LIC126) in English and Chinese. LPA printed Employee Rights (LIC9052) and Statement Acknowledging Requirement to report Child Abuse (LIC9108) in Chinese.

Facility evaluation report was reviewed and discussed with licensee. Exit interview was conducted. 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: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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