414002549-10-5-2021-05-CC-AZEA-CA8USP-20211231145040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414002549
Report Date: 10/05/2021
Date Signed: 10/05/2021 05:00:42 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
10/04/2021 and conducted by Evaluator Cindy Mok

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20211004110221

FACILITY NAME:	XU, JUN		FACILITY NUMBER:	414002549
ADMINISTRATOR:	XU, JUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 249-0298
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94065
CAPACITY:	14	CENSUS: 10	DATE:	10/05/2021
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Jun Xu and Catherine Ma		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Provider locks the day care children in a room

INVESTIGATION FINDINGS:

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LPA Mok conducted an unannounced inspection for the comoplaint today. LPA met with the licensee, Jun Xu, and her daughter, Catherine Ma. The purpose of the inspection was explained to them. There were 10 children that included 4 infants with 2 staff present. LPA interviewed the licensee and her daughter during the inspection. Based on the interviews, licensee latches the door of a room from outside to prevent the older children get into the same room when the young children playing in the room with a teacher and prevent the chldren hurt their fingers by the door.

Based on the interviews which were conducted, 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 12 & Chapter 3), are being cited on the attached LIC 9099D.”)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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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Control Number 05-CC-20211004110221

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: XU, JUN	FACILITY NUMBER: 414002549
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/05/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/05/2021 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	102423(a)(2) Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:	1 2 3 4 5 6 7	Licensee took off the latches from the rooms in the daycare during the inspection. The deficiency was cleared during the inspection.
	8 9 10 11 12 13 14	(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. licensee latches the door of the room from outside to prevent the older children get into the same room when the young children playing in the room with a teacher and prevent the chldren hurt their fingers by the door. .This poses a potential health risk to 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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC9099 (FAS) - (06/04)

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