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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416263
Report Date: 02/23/2022
Date Signed: 02/23/2022 04:28:00 PM

Document Has Been Signed on 02/23/2022 04:28 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BI, XIAOWENFACILITY NUMBER:
434416263
ADMINISTRATOR:XIAOWEN BIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 508-0471
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Xiaowen BiTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced visit to the facility to amend a citation by correcting violation CCR section # cited on 12/21/2021, and changing the civil penalty assessment amount & violation code. LPA met with Licensee Xiaowen Bi and explained the nature of today’s inspection to Licensee. LPA observed licensee's mother and no daycare children.

Exit interview conducted with Licensee. NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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