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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416219
Report Date: 10/24/2023
Date Signed: 10/24/2023 02:54:58 PM

Document Has Been Signed on 10/24/2023 02:54 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ZHANG, LUFACILITY NUMBER:
434416219
ADMINISTRATOR:LU ZHANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 386-3325
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced Case Management inspection at the facility today. The purpose of today’s inspection is to ensure that licensee, Lu Zhang, continues to adhere to the Temporary Suspension Order (TSO) issued by the Department on 09/21/2023.

LPA arrived and observed the facility from 11:25am to 11:40am. The TSO was posted on the front entrance. LPA took a picture of the TSO. No one, including adults and children, was seen in or out of the facility. At 11:40am LPA pressed the Ring with camera and no one answered the door. No noises or other sounds came out of the facility. LPA pressed the Ring several times and still no one answered the door. Around 11:45am LPA left the facility.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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