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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700329
Report Date: 01/20/2023
Date Signed: 01/20/2023 02:59:32 PM

Document Has Been Signed on 01/20/2023 02:59 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:LEE, POU LENGFACILITY NUMBER:
015700329
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
01/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Pou Leng "Qiana" LeeTIME COMPLETED:
09:30 AM
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On 01/20/2023 at 8:45am, Licensing Program Analyst (LPA) Christina Uribe conducted an announced Case Management visit and met with licensee, Pou Leng "Qiana" Lee. The purpose of today's visit is to inspect two previously off-limit rooms of the home and change them to on-limit areas. Present during today's inspection is the licensee's fingerprint cleared husband, Kent Lee, and 4 day care children.

LPA Uribe received a new Facility Sketch (LIC 999A) from the licensee which indicates that two rooms (1 bedroom and 1 bathroom) which were previously off limits to children in care have been switched with two other rooms (another bedroom and bathroom) which were previously on limits.

The newly designated rooms are as follows:

Off-Limit Areas: The third bedroom (bedroom #3) and bathroom at the end of the hall and the garage.

On-Limit Areas: The primary bedroom, primary bathroom, second bedroom, kitchen, living room, and back yard.

LPA Uribe has inspected the newly on-limit areas and all areas are neat, clean, and furnished for appropriate day care use for safety and comfort to children. The licensee's request for a change in designated on/off-limit areas of the home has been approved as of today, 01/20/2023.

Notice of Site Visit was given and must be posted for 30 days. Exit interview was conducted and report was reviewed with the licensee, Pou Leng "Qiana" Lee.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023
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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