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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700335
Report Date: 07/23/2021
Date Signed: 07/23/2021 10:38:57 AM

Document Has Been Signed on 07/23/2021 10:38 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ZHENG, XINGXINFACILITY NUMBER:
435700335
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
07/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Xingxin ZhengTIME COMPLETED:
10:50 AM
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 Friday, July 23, 2021 9:00 AM, Licensing Program Analyst (LPA) Manel Estoesta conducted an announced Pre Licensing Visit. LPA met with the applicant Xingxing Zheng. Present on this visit were applicant's spouse and applicant's daughter. The applicant has submitted an application for Small Family Child Care Home (FFCH) License. Hours of operation will be from Monday to Friday 8:30 AM to 5 PM.

LPA toured the facility to conduct a health and safety inspection. The home is a two story home with four (4) bedroom, two (2) bathrooms, living room, kitchen, dinning area, laundry room, garage and front and back yard. The home is neat and clean with central heating and ventilation for safety and comfort. The home does not have a fireplace.

The OFF-LIMIT AREAS are the entire second 2nd floor, kitchen, garage, front yard and laundry room will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are living room, dining room, bathroom in the first floor and the backyard. The designated isolation area will be living room. The backyard will be a designated outdoor play area that is fully fenced. The outdoor area has age appropriate toys that appear to be clean and free from defects and dangerous conditions. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a does not have charged fire extinguisher, working combination of smoke detector and carbon monoxide, working cell phone and fully stocked first aid kit. Per applicant, there are no firearms on the premises.

The applicant completed the Health and Safety training on and CPR (Pediatric) and First Aid. The applicant has proof of immunization and has not completed the mandated reporter training, discussed with applicant it must be renewed every two years.

SEE 809 C....

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ZHENG, XINGXIN
FACILITY NUMBER: 435700335
VISIT DATE: 07/23/2021
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
26
27
28
29
30
31
32
Conitnuation....

The applicant owns the home and provided a copy of Mortgage Statement dated 07/01/2021.
LPA discussed the following;

1. The Applicant need to have a required Fire Extinguisher. The applicant has only 1A10BC. Applicant stated that she will purchase a new Fire Extinguisher requirement and will submit to LPA a proof of purchased or a photo showing Fire Extinguisher installation.
2. The Applicant will complete the AB 1207 Mandated Reporter Training online and will submit a certificate copy to LPA.
3. A Pre licensing packet including forms pertaining to the children’s files and facility files.

The home is not recommended for a Small FCCH License at this time. The applicant understands that license will be granted upon completion of the requirement discussed on this visit.

Exit interview conducted to the applicant.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2