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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421741
Report Date: 10/22/2019
Date Signed: 10/22/2019 01:59:29 PM



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
10/17/2019 and conducted by Evaluator Mayla Mendoza
COMPLAINT CONTROL NUMBER: 52-CC-20191017160243
FACILITY NAME:LIN, YANGJINFACILITY NUMBER:
013421741
ADMINISTRATOR:LIN, YANGJINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 308-6706
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:14CENSUS: 6DATE:
10/22/2019
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Yangjin LinTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Other-operating out of capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mayla Mendoza met today with licensee Yangjin Lin to investigate on the allegation above. This agency has investigated the complaint alleging the licensee is operating out of capacity. Today, there were 4 infants and 2 preschool children with no assistant present. .

Based on LPAs observations and interviews which were conducted today and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC. 9099D.

An Acknowledgment of Receipt of Licensing Report form must be signed by parents of children in care and parents must receive a copy of the report containing the type A deficiency(s), by the next business day or the next day a child returns to the day care. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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 2
Control Number 52-CC-20191017160243
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: LIN, YANGJIN
FACILITY NUMBER: 013421741
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2019
Section Cited
CCR
102416.5(e)
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(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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By 10/24/19-LPA Mayla Mendoza will return on another day to ensure compliance with capacity requirements.
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This requirement is not met as evidenced by licensee caring for 4 infants and 2 preschool children with no assistant present today. This violation poses an immediate health and safety risk to the children in care.
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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) 622-2593
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2