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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004514
Report Date: 06/27/2022
Date Signed: 06/27/2022 03:08:57 PM

Document Has Been Signed on 06/27/2022 03:08 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:HUANG, DONGLIFACILITY NUMBER:
384004514
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Dongli HuangTIME COMPLETED:
03:06 PM
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Licensing Program Analyst (LPA) Sheran Lo conducted an announced case management inspection today. LPA met with the licensee, Dongli Huang. The purpose of the inspection was explained to her. There is no children present.

The case management is related to licensee’s request. Licensee requested to include the downstairs in-law Bedroom 1, Bathroom, and Living Room for childcare use. LPA toured the rooms and inspected for safety hazards. All off-limit areas are barricaded with gates. There are a variety of age appropriate toys available to the children. The stairway is blocked with locked doors/gates inaccessible to children. LPA approved these rooms for childcare as of today. First Follor: Living room, bedroom 1, Back office, and hallway bathroom. The off-limit areas are: upstairs level Bedrooms, Bathroom 2, Kitchen, and Dining room; first floor bedroom 2, kitchen, and garage.

This report was explained and provided to the licensee. The notice of site visit was given.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2022
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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