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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004213
Report Date: 12/01/2021
Date Signed: 12/01/2021 01:42:38 PM

Document Has Been Signed on 12/01/2021 01:42 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ZHANG, XIUZHENFACILITY NUMBER:
384004213
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Xiuzhen ZhangTIME COMPLETED:
12:00 PM
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Licensing Program Analyst, LPA Yee conducted an annual inspection today. The purpose of the inspection was explained. Current residents are licensee, XiuZhen Zhang aka "Jenny", her husband, adult daughter, 18-year-old son, and a tenant. Son just turned 18 years old, licensee said she will get him fingerprint clear ASAP. Present at the facility is a licensee, her husband, and three daycare children. LPA inspected the home and observed the following today. There are no pets in the home. The fireplace in the living room is properly barricaded. Daycare areas (upper level): living room, dining room, bedroom #1 for napping (inspected during the inspection, approved), and bathroom. A childproof gate is maintained in the daycare areas. The remaining areas of the home are off-limit. The backyard is not licensed today. Licensee wishes to add the backyard but is not ready today. She will call to notify me when she is ready. The home is equipped with a fully charged fire extinguisher, smoke alarm, and carbon monoxide detector. Toxins are made inaccessible. The home is free of hazardous materials. The licensee has current First aid and CPR certificate which expires on 11/06/2023. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207.
https://www.mandatedreporterca.com/ .Licensee took the wrong class. She said she will renew AB1207 and will send a copy of the certificate to CCL ASAP. The licensee states the following: There is a gun in the home which is kept in Bedroom #1, which is off-limits. Ammunition and gun are maintained separate, each kept in a locked box, out of the reach of children. There are no other weapons in the home. Liability insurance is maintained. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. 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: http://www.ada.gov/childqanda.htm.A written IMS plan was obtained today. Safe Sleep was discussed today.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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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