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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101698
Report Date: 03/21/2025
Date Signed: 03/21/2025 03:11:30 PM

Document Has Been Signed on 03/21/2025 03:11 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:XU, SHUIRONG FAMILY CHILD CAREFACILITY NUMBER:
376101698
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/21/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Shuirong XuTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 03/21/2025 @ 12:00 p.m., LPA Mahjoba Mohsini conducted an unannounced comprehensive visit for the purpose of an Annual Inspection and increase of capacity. LPA was greeted at the door by the Licensee, Shirong Xu and LPA was granted entry after identifying self and disclosing the purpose of the visit. Present were also assistant (Jingmin Liu) and Licensee's husband (Chengzhong Jiao). During this visit, there were  6 children in care.  The facility is within ratio and capacity.  Enrance checklist was provided.

A tour of the two-story home (4 bedrooms, 3 bathrooms, garage and fenced back yard) was conducted.  Childcare areas are: formal living room, informal living/dining area, kitchen, bathroom #1, and fenced backyard. Off limit areas include: all upstairs (bedrooms #1- #4) and bathrooms #2 & #3 and have been made inaccessible by use of removable child gate.  Licensee is also using garage for occasional play time to avoid napping children. Licensee stated there are no weapons in the home. There are no bodies of water on the facility property. There is a fireplace in the informal living room and has been barricaded. Poisons, detergents, cleaning solutions, medications are made inaccessible through use of latches and locks.

LPA tested the smoke alarm and carbon monoxide detectors located in the kitchen and they were operational. The fire extinguisher is fully charged (located in the laundry room) and meets regulations. Emergency drills are being conducted and logged at least every six months and there is a written Disaster Plan on file.   The home is clean, orderly with adequate ventilation and heating.  Licensee has provided enough space for the children to eat, sleep and play within the home. The furniture, to include napping materials and children’s toys, books and activities are safe and age appropriate and in good repair. Licensee has checked for recalled items. Children will be observed upon entry and throughout the day for signs of illness. An appropriate isolation area has been established for sick children. There is a working telephone, and all required forms are posted. Outdoor play space is fully fenced with age-appropriate play equipment and activities in good repair. No hazards were noted.  Licensee understands there is no smoking in or around day care areas. 

(continued on 809C...)
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: XU, SHUIRONG FAMILY CHILD CARE
FACILITY NUMBER: 376101698
VISIT DATE: 03/21/2025
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Children’s files were reviewed and found to be complete. There are no school age children present are enrolled. The facility roster was current and complete and is being stored for 3 years. Licensee's pediatric CPR/FA certificate with ABC valid through 09/2025 and Mandated Reporter Training is waived due to language. Licensee and her assistant speak Chinese.

LPA and Licensee discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Licensee is to be present in the home to ensure children are supervised and reminded that no children are to be left in parked vehicles and car seats are not to use used for sleeping. Capacity limitations were reviewed. LPA discussed California Megan's Law and the website was provided as follows:  www.meganslaw.ca.gov

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: XU, SHUIRONG FAMILY CHILD CARE
FACILITY NUMBER: 376101698
VISIT DATE: 03/21/2025
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Licensee is advised to sign up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.  Select “Child Care” then “Quick Links” and Quarterly Updates. Select “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and select “subscribe.” 

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Exit interview conducted and report was reviewed with the licensee Shuirong Xu. During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies are cited.
NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. 
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
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