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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420448
Report Date: 05/01/2024
Date Signed: 05/01/2024 02:13:47 PM

Document Has Been Signed on 05/01/2024 02:13 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HE, ZHIFACILITY NUMBER:
013420448
ADMINISTRATOR/
DIRECTOR:		HE, ZHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 290-3827
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 10DATE:
05/01/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Li Hu/Zhi HeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 5/1/24, at 1:30PM, Licensing Program Analyst (LPA) Brittany Crass, arrived at the home for an unannounced visit to follow up on deficiencies that were cited on 3/21/24. LPA met with the licensees fingerprint cleared son, Hu Li to explain the purpose of the visit. The licensee was not present in the home upon LPA's arrival, but came later at 1:40PM.

No deficiencies are being cited today.

Exit interview conducted with the licensee. Appeal rights were given. Notice of site visit was given and must remain posted for 30 days. Report reviewed with Zhi He.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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