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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004634
Report Date: 08/03/2022
Date Signed: 08/03/2022 01:49:05 PM

Document Has Been Signed on 08/03/2022 01:49 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LI, HONG XINGFACILITY NUMBER:
414004634
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/03/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Hong Xing LiTIME COMPLETED:
01:00 PM
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On August 03, 2022 at approximately 11:55am, Licensing Program Analyst (LPA) Winnie Ly conducted a Case Management Visit initiated by licensee for an increase of capacity, from a small family child care to large family child care. LPA arrived to this family child care home and met with Licensee Hong Xing Li. Purpose of visit was explained. Present during the visit was Licensee caring for 3 children, 2 of whom are licensee's minor children.

Day Care is on the first level of the home. Day Care Areas are family room in the back of the house, bedroom #1(next to the family room), a hallway bathroom, and backyard. Off Limit Areas are the entire upper level, bedroom #2 (Applicant’s room), living room, dining room, garage, and both side yards.

Licensee's CPR/First Aid is up to date and will be expired 08/2023. Licensee also has completed Child Abuse Mandated Reporter Training Certificate on File.

LPA observed the home is clean orderly and properly ventilated. LPA also observed a 2A10BC Fire extinguisher, operable smoke detectors and carbon monoxide. There are no Fireplace or bodies of water in the home. Electrical outlets have child protective covers in place making them inaccessible to children. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. Kitchen/Bathroom cabinets/drawers have child protective locks in place making all sharp objects or toxic house hold items inaccessible to children. First aid supplies are available for children.

Fire Clearance has been granted by the South San Francisco Fire Department on 07/07/2022.

Large Family Child Care License is approved effective 08/03/2022.

A copy of this report and appeal rights were discussed and will be emailed to Licensee whose signature on this form confirm have read the report. Notice of Site Visit will also be emailed to licensee. Licensee was advised Notice of Site Visit to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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