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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845981
Report Date: 10/03/2024
Date Signed: 10/03/2024 01:19:15 PM

Document Has Been Signed on 10/03/2024 01:19 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SHEN FAMILY CHILD CAREFACILITY NUMBER:
364845981
ADMINISTRATOR/
DIRECTOR:		YUZHEN WANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 860-5818
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Wei ShenTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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A case management follow-up visit to annual visit on 09/25/24 is being conducted to verify POCs completed and to address licensee initiated clarification on regulations regarding responsibilities of Licensees. LPA was greeted and granted entry by Licensees, Wei Shen and Yuzhen Wang.

During today’s visit, LPA Carbullido verified the following POCS have been completed:
1. The kitchen was made inaccessible to children-. Licensee has confirmed kitchen area to remain off limits. LPA reviewed process to submit a written request and new facility sketch if Licensees make changes to on/off limit areas and may require a case management visit.
2. LPA toured facility and observed no cleaners/hazards accessible including bathroom.
3. A second gate was added to stairwell to ensure no children access the second floor.
4. LPA viewed safe sleep 15-minute logs in use for infants enrolled.
5. Fire drill completed, children’s immunizations, and mandated reporter received.

Licensee Wei Shen requested a change in their status as Licensee and submitted a new 279A during today’s visit; Licensee- Yuzhen Wang will remain on license. LPA discussed and reviewed responsibility for any Licensee providing care to understand and maintain Title 22 Division 12 California Code of Regulations as required for the operation of a family childcare home, including all required certificates.

An exit interview was conducted, and LPA Carbullido provided Licensees Wei Shen, Yuzhen Wang and with a copy of this report, appeal rights and notice of site visit during today’s visit.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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