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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004998
Report Date: 05/17/2024
Date Signed: 05/17/2024 01:17:56 PM

Document Has Been Signed on 05/17/2024 01:17 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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WANG, ZHONGLINFACILITY NUMBER:
414004998
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
05/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Michael Shen & Zhonglin WangTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On May 16 th, 2024 Licensing Program Analyst (LPA) Kassandra Medrano conducted an unannounced Case Management- Licensee Initiated inspection. LPA was granted access by helper, Julieth Lopez. During todays inspection LPA met with Licensee, Zhonglin and Licensees son, Michael. LPA explained the reason for the inspection. Licensee has requested to add the back yard as space used by children which was previously marked as off limits. At 12:05 Michael Shen entered home, later at 12:10 Zhonglin entered home. Present during today's inspection were Zhonglin, Michael Shen, and helpers Julieth Lopez and Nurten Sengul. Upon arrival, Helpers were present with 6 children (3 infants and 3 preschool aged children).
LPA spoke to Michael about proper postings and required documentation for staff and children. The hours of operation are Monday through Friday, 8am-6pm. There is working phone in the home. LPA toured in the inside and outside of the home. The off-limit areas of the home are: bedroom #2, unit #434, garage, side yard and partial of front yard. Disinfectant, cleaning supplies, and other items that are dangerous to children were observed to be inaccessible. Equipment and toys were age appropriate and in good condition. The toys and play equipment were observed to be in good condition. There were no bodies of water observed during today's inspection. During the exit interview, the Licensee, Zhonglin, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. 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.

As a result of this inspection, no deficiencies were issued and yard is approved for use. Exit interview conducted and report was reviewed with the Licensee, Zhonglin.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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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