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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845697
Report Date: 10/16/2024
Date Signed: 10/16/2024 10:23:51 AM

Document Has Been Signed on 10/16/2024 10:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ZHOU FAMILY CHILD CAREFACILITY NUMBER:
364845697
ADMINISTRATOR/
DIRECTOR:		SHAOBIN ZHOUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 274-4832
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Shaobin ZhouTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 10/16/24 at 9:50 am, Licensing Program Analyst (LPA) Patricia Berry conducted a case management/incident investigation. LPA met with licensee, toured facility and took a census.

On 10/7/24 the RO received an Unusual Incident Report regarding a parent alleging the licensee inflicted physical pain on the child. Licensee stated there were no injuries to the child.

Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the licensee.

An exit interview was conducted and a copy of this report, appeal rights and notice of site visit issued. was provided to facility staff.

Notice of site Visit must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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