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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420318
Report Date: 08/03/2022
Date Signed: 08/03/2022 04:04:56 PM

Document Has Been Signed on 08/03/2022 04:04 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ZHANG, JUNFACILITY NUMBER:
013420318
ADMINISTRATOR:ZHANG, JUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 676-8125
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 19DATE:
08/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jun ZhangTIME COMPLETED:
04:24 PM
NARRATIVE
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Licensing Program Analyst (LPA) Otsuji arrived to the facility unannounced to conduct a Case Management - Deficiencies Inspection. Present during today's visit was the Licensee, two fingerprint cleared assistants, and 19 children (5 infants, 14 preschoolers). LPA conducted a health and safety inspection of the facility.

The following corrections from a previous visit have been made: 1) 102370(d) S1 has now received fingerprint clearance and is allowed to be on the premises. Copy of Cleared POC's letter provided.

However, on today's date, 8/3/2022 at 2:25PM LPA conducted a physical plant tour. It is noted that LPA conducted a census and 12 children were present within the main day care room. LPA then requested to see the rest of the home. Licensee showed LPA the main home and within the home were 7 children and a fingerprint cleared staff member. Putting Licensee over the license capacity. Please see LIC809D for TYPE A citations.

Licensee is aware a Non-Compliance Conference will be scheduled in the near future.

The attached type A violations are cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and appeal rights provided to Licensee, Jun Zhang.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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Document Has Been Signed on 08/03/2022 04:04 PM - It Cannot Be Edited


Created By: Melanie Otsuji On 08/03/2022 at 02:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHANG, JUN
FACILITY NUMBER: 013420318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2022
Section Cited
HSC
1596.8897

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Health and Safety Code Section 1596.8897: Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California.
This requirement is not being met as evidence by:
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Licensee is to submit a signed declaration stating she understands she is to be forthcoming with licensing and that she will be cooperative with the inspection process. Signed declaration to be submitted to LPA by 8/4/2022.
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Licensee is not being forthcoming about the children in care. Additionally, Licensee was not cooperative with the inspection process. Licensee informed LPA only 12 children were present. LPA counted 12 children in day care room and 7 more children in main home which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
08/04/2022
Section Cited
CCR102416.5(d)(2)

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(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
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By 8/4/2022--licensee shall have reduced her capacity to the maximum number of children for whom care can be provided. LPA to revisit to ensure Licensee is staying within ratio.
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Based on record review and interview, the licensee did not comply with the section cited above in Licensee had 19 children present which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022


LIC809 (FAS) - (06/04)
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