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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101175
Report Date: 10/18/2023
Date Signed: 10/18/2023 09:07:40 AM

Document Has Been Signed on 10/18/2023 09:07 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WEN, MIAOXIN & JESSE FAMILY CHILD CAREFACILITY NUMBER:
376101175
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
10/18/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Miaoxin WenTIME COMPLETED:
09:15 AM
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On 10/18/2023 at 8:20am, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced plan of correction inspection. Upon arrival, LPA met with licensee Miaoxin Wen at the facility supervising two day care children. During the inspection another day care child was dropped off.

LPA conducted a tour of the day care areas and hazardous items is not accessible to children. Also all adult residents and helper are associated to the facility. Licensee recently conducted a fire drill with the children in care on 10/02/2023 and an updated facility roster was obtained.

LPA reviewed six of the children's file that are currently enrolled and five out of six of the files are missing one or more documents.

LPA provided licensee with the documents that are missing in the children's file today. Licensee will submit the missing documents to LPA within 5 days prior to granting a capacity increase.

Notice of site visit shall be posted at the facility for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2023
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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