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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101175
Report Date: 03/29/2024
Date Signed: 03/29/2024 11:05:12 AM

Document Has Been Signed on 03/29/2024 11:05 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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WEN, MIAOXIN & JESSE FAMILY CHILD CAREFACILITY NUMBER:
376101175
ADMINISTRATOR:MIAOXIN & JESSE WENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 237-7707
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
03/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jesse WenTIME COMPLETED:
11:35 AM
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On March 29, 2024 at 10:20 AM., Licensing Program Analyst (LPA), Sherlynn Banas conducted an unannounced Case Management Visit for the purpose of delivering amended reports previously provided on 3/27/24 as well as providing civil penalty forms LIC421 BG and LIC421 FC for citation previously issued on 3/27/24.

At arrival, LPA met with Jesse Wen. There were 6 day care children present in the home with 2 staff.
On this day LPA also received a signed copy of criminal transfer request form (LIC 9182).

Exit interview conducted and report was reviewed with the licensee, Jesse Wen.

A Notice of Site visit was given to licensee, Jesse Wen and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2024
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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