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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420349
Report Date: 05/17/2021
Date Signed: 05/17/2021 12:17:34 PM

Document Has Been Signed on 05/17/2021 12:17 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LAI, DE ZHENFACILITY NUMBER:
013420349
ADMINISTRATOR:LAI, DE ZHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 559-3178
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/17/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:De Zhen LaiTIME COMPLETED:
12:10 PM
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On May 17, 2021, Licensing Program Analyst (LPA), Caroline Colson met with De Zhen Lai for a virtual case management inspection at 10:02 AM. Mrs. Lai, her husband, Zanshan Wu and her adult son, Jerry Wu were present for the virtual inspection. Mr. Jerry Wu assisted with language interpretation. All adults living and working in the home have criminal record clearances. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are 8:00 AM to 6:00 PM on Monday - Friday.

The home is a one story apartment within a duplex complex. The home consists of two bedrooms, living room, a bathroom, a shared fenced front yard, shared fenced back yard and carport. The shared fenced front yard, shared fenced back yard and carport is being used as the outdoor play space. The second bedroom, kitchen and second apartment are the off-limit areas. There is 3A40BC fire extinguisher, working carbon monoxide detector and a working smoke detector. Per Mrs. Lai states that there are no firearms in the home. There are toys available for the children. Her CPR and First Aid certificates are current and expire on July 2021. Mrs. Lai has a screened wall heater in the living room. The isolation area will be the master bedroom. All required documents are posted in the home. There are no pets. Her annual fees are current.

Licensee submitted a COVID-19 Self-Assessment Guide. LPA reviewed responses with applicant and provided technical assistance including postings.

Please See LIC 809 C for additional information





SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LAI, DE ZHEN
FACILITY NUMBER: 013420349
VISIT DATE: 05/17/2021
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REMINDERS/RESOURCES
· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

There were no deficiencies cited today.

The license to return back to ACTIVE status and will be effective on May 17, 2021.

An exit interview was conducted. Appeal rights were discussed. This report must be available for public review for 3 years.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
LIC809 (FAS) - (06/04)
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