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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002531
Report Date: 01/11/2021
Date Signed: 01/11/2021 02:35:55 PM



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
11/02/2020 and conducted by Evaluator April Cowan
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20201102153031
FACILITY NAME:WU YEE CHILDREN'S SERVICES-WESTSIDE CCC (PS)FACILITY NUMBER:
384002531
ADMINISTRATOR:VIRGIE STREETSFACILITY TYPE:
850
ADDRESS:2400 POST STREETTELEPHONE:
(415) 677-0100
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY:30CENSUS: 10DATE:
01/11/2021
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Virgie StreetsTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not accommodate child's needs.
INVESTIGATION FINDINGS:
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On 1-11-21 at 9:50 AM, Licensing Program Analyst (LPA) Cowan contacted site director to close complaint. This was done by phone call due to Covid-19 State of Emergency. The purpose of the call was explained to director.

During the course of investigation, interviews were conducted with director, staff, parents, and children. After considering evidence in interviews, it has been determined that staff did not accommodate a child's needs by allowing a child to go to the bathroom when requested.

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

This report is emailed to site director with a request for reply demonstrating receipt.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
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 3
Control Number 05-CC-20201102153031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WU YEE CHILDREN'S SERVICES-WESTSIDE CCC (PS)
FACILITY NUMBER: 384002531
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/22/2021
Section Cited
CCR
101223(a)(1)(3)
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101223-Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by:

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Director agrees to meet with and train staff on how to respectfully communicate with children and allow children to go to the bathroom when necessary. Director agrees to submit a copy of meeting agenda/talking points to LPA no later than 1-22-21.
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Based on observations and interviews, staff did not allow a child to go to the bathroom when requested. This poses a potential risk for 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
11/02/2020 and conducted by Evaluator April Cowan
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20201102153031

FACILITY NAME:WU YEE CHILDREN'S SERVICES-WESTSIDE CCC (PS)FACILITY NUMBER:
384002531
ADMINISTRATOR:VIRGIE STREETSFACILITY TYPE:
850
ADDRESS:2400 POST STREETTELEPHONE:
(415) 677-0100
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY:30CENSUS: 9DATE:
01/11/2021
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Virgie StreetsTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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9
Facility staff yelled at child

Facility staff left child unsupervised
INVESTIGATION FINDINGS:
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On 1-11-21 at 9:50 AM, Licensing Program Analyst (LPA) Cowan contacted site director to close complaint. This was done by phone call due to Covid-19 State of Emergency. The purpose of the call was explained to director.

During the course of investigation, interviews were conducted with director, staff, children, and parents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

This report is emailed to site director with a request for reply demonstrating receipt.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
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 3