<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845697
Report Date: 10/17/2024
Date Signed: 10/17/2024 02:10:17 PM

Document Has Been Signed on 10/17/2024 02:10 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
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:
10/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH: Shaobin Zhou/licenseeTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/17/24 1:00 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management/incident investigation to deliver final report. LPA met with licensee, toured facility, and took a census.

On 10/7/24 the RO received an Unusual Incident Report alleging the licensee inflicted physical pain on the child.

Pertinent parties were interviewed. Licensee stated there were no injuries to the child. Other interviews revealed conflicting information. LPA observed photos of the child from 10/3/24: child's last day of childcare. The photos show the child smiling and playing with other children. There were no visible marks on the child's face or hands in the photos. On 10/4 the child never came into the daycare. LPA asked for photos of the injuries of the child and none were provided.

Based on information gathered, the facility acted appropriately, and no violations have been identified at this time. Licensee reported the incident to Community Care Licensing in a timely manner.

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

Notice of site visit must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1