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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420045
Report Date: 04/11/2022
Date Signed: 04/11/2022 12:41:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2022 and conducted by Evaluator Jyoti Saini
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220314124021
FACILITY NAME:CHEN, WEIFACILITY NUMBER:
013420045
ADMINISTRATOR:CHEN, WEIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 351-2677
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 11DATE:
04/11/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Staff member Ling Yu and Licensee Chen WeiTIME COMPLETED:
12:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Staff hitting children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 Licensing Program Analyst (LPA) Jyoti Saini arrived unannounced to deliver the findings from a complaint investigation for the above allegation and met the assistant teacher Ling Yu. The Provider arrived during the inspection. Present were licensee and three staff members supervising 11 children (one infant, ten preschoolers)
Based on interviews and record reviews, the licensee and S1 admitted that there was one incident where C1 was jumping high from the steps in the play yard. S1 repeatedly reminded C1 to stop jumping since she was concerned that C1 might break his/her arm or get hurt. When C1 did not stop, S1 got frustrated and hit the child. S1 admitted that she regretted her behavior. S1 did not ensure C1s safety when she hit C1 and violated C1's personal rights, which poses an immediate risk to the health and safety of children in care. The preponderance of evidence standard has been met; therefore, the allegation of staff hitting the children is SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter Number 102423) are being cited on the attached LIC 9099D

An exit interview was conducted with Licensee, Chen Wei. A notice of site visit was posted and must remain posted for a period of 30 days. The Facility's appeal rights were reveiwed and given to the Licensee, Chen Wei.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 52-CC-20220314124021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, WEI
FACILITY NUMBER: 013420045
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2022
Section Cited
CCR
102423(a)(4)
1
2
3
4
5
6
7
102423(a)(4) Personal Rights
(a)Each child receiving services from a family child care home shall............. but are not limited to, the following: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule,........ ........or withholding shelter, clothing, medication or aids to physical functioning.
This requirement is not met as evidenced by:

1
2
3
4
5
6
7
 Licensee and staff shall watch the licensing video on Children's Personal Rights in Child Care on the CCL website. Each staff is to write a statement indicating their understanding of personal rights, and how they will ensure that the personal rights of children are always protected. Submit statements to LPA by due date of 04/12/22.
8
9
10
11
12
13
14
Based on interviews and record review, S1 did not ensure C1s safety when she hit C1 and violated C1's personal rights, which poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2022 and conducted by Evaluator Jyoti Saini
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220314124021

FACILITY NAME:CHEN, WEIFACILITY NUMBER:
013420045
ADMINISTRATOR:CHEN, WEIFACILITY TYPE:
810
ADDRESS:412 LLOYD AVE.TELEPHONE:
(510) 351-2677
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 11DATE:
04/11/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Staff member Ling Yu and Licensee Chen WeiTIME COMPLETED:
12:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Staff do not ensure a safe and healthful environment
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jyoti Saini arrived unannounced to deliver the findings from a complaint investigation for the above allegation and met the assistant teacher Ling Yu. The Provider arrived during the inspection. Present were licensee and three staff members supervising 11 children (one infant, ten preschoolers)
During the course of the investigation, LPA reviewed documents, and conducted interviews. LPA obtained evidence showing that S1 got frustrated and hit the child, violated C1's personal rights,which poses an immediate risk to the health and safety of children in care. The preponderance of evidence standard has been met; therefore, the allegation of Staff do not ensure a safe and healthful environment is SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter Number 102423) are being cited on the attached LIC 9099D

An exit interview was conducted with Licensee Chen Wei. A notice of site visit was posted and must remain posted for a period of 30 days. The Facility's appeal rights were reveiwed and given to the Licesee, Chen Wei.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 52-CC-20220314124021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, WEI
FACILITY NUMBER: 013420045
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2022
Section Cited
CCR
102423(a)(1)
1
2
3
4
5
6
7
102423(a)(1) Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights ......, but are not limited to, the following:
(1) To be treated with dignity in his/her personal relationship with staff and other persons.
This requirement is not met as evidenced by:

1
2
3
4
5
6
7
Licensee and staff shall watch the licensing video on Children's Personal Rights in Child Care on the CCL website. Each staff is to write a statement indicating their understanding of personal rights, and how they will ensure that the personal rights of children are always protected. Submit statements to LPA by due date of 04/12/22.
8
9
10
11
12
13
14
Based on interviews and record review, S1 did not ensure C1s safety when she hit him and violated C1's personal rights, which poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4