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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700339
Report Date: 11/30/2022
Date Signed: 12/05/2022 09:24:57 AM

Document Has Been Signed on 12/05/2022 09:24 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:FAN, SITINGFACILITY NUMBER:
435700339
ADMINISTRATOR:FAN, SITINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 229-4527
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
11/30/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Siting "Gracie" FanTIME COMPLETED:
12:30 PM
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On 11/30/2022 at 11:30am, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced case management inspection as requested by the licensee. LPA Uribe met with licensee, Siting "Gracie" Fan and also present during today's visit is 3 day care children.

The purpose of today's visit is to inspect the kitchen to convert the room from an off-limit area to on-limits. Licensee has provided LPA Uribe a revised and updated Facility Sketch (LIC 999) in which the kitchen is on-limits. LPA Uribe inspected the kitchen and found the room to be neat, clean, and free from hazardous materials which could pose a risk to children in care.

As of today, 11/30/2022, the kitchen of the Family Child Care Home is approved to be an on-limit area of the home which will be accessible to children in care. Licensee is reminded to keep all cleaning supplies, sharp objects, and hazardous items out of reach from children in care at all times.

The on-limit areas of the home are now the kitchen, living room, two front bedrooms, bathroom, dining area, and the backyard.

The off-limit areas of the home are now the back bedroom and the detached garage.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee, Siting "Gracie" Fan.

***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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