384000668-9-27-2019-05-CC-AMAG-BHDL5Y-20191028082752

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384000668
Report Date: 09/27/2019
Date Signed: 09/27/2019 11:41:00 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/12/2019 and conducted by Evaluator Cindy Interiano

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20190212162220

FACILITY NAME:	CAI, XIU HUA & LAU, OLIVIA W.		FACILITY NUMBER:	384000668
ADMINISTRATOR:	CAI, XIU HUA & LAU, OLIVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 242-0965
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY:	14	CENSUS: 7	DATE:	09/27/2019
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Licensee, Olivia W. Lau		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

1
2
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5
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7
8
9

Child sustained severe injuries while in care due to Neglect/Lack of supervision

INVESTIGATION FINDINGS:

1
2
3
4
5
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7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Cindy Interiano conducted a subsequent unannounced complaint inspection, and met with Licensee, Olivia W. Lau. Present in the facility is Licensee, and 2 Helpers caring for 7 children (2 infants and 5 PreK).
Purpose of the inspection was to discuss the above allegation. On 06/18/19, allegation was determined substantiated. Licensee appealed the deficiency issued. Based on Regional Manager’s review, the deficiency of Lack of Supervision, along with a civil penalty, has been dismissed. Letter dismissing the Deficiency has been given to Licensee.
Although the allegation of a child sustaining severe injuries while in care due to Neglect/Lack of supervision may have happened or may be valid, based on the information obtained by Investigations Bureau (IB) Investigator, Shanie Churchwell, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are found to be 'UNSUBSTANTIATED.'

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Chapt. 1.***

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment and appeal have been discussed with Licensee. Notice of Site Visit was observed being posted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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