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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004693
Report Date: 04/26/2021
Date Signed: 04/26/2021 04:22:43 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
03/15/2021 and conducted by Evaluator Winnie Ly
COMPLAINT CONTROL NUMBER: 05-CC-20210315164957
FACILITY NAME:KUO, WAN YUFACILITY NUMBER:
414004693
ADMINISTRATOR:KUO, WAN YUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 380-8555
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:14CENSUS: 12DATE:
04/26/2021
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Wan Yu Kuo (aka Alice)TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee operates beyond the terms and conditions of the license. Per Complainant, Licensee using off limit areas for day care children.
INVESTIGATION FINDINGS:
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Due to COVID-19 and DPH guidelines of social distancing, Licensing Program Analyst (LPA) Winnie Ly conducted a teleconference with Licensee Wan Yu Kuo (aka Alice) on April 26, 2021 to close this complaint. During this investigation, LPA interviewed complainant, licensee, victim, parents and staff. As part of this investigation, LPA also collected children’s roster, staff roster, parent's handbook and pictures.

Based on information obtained, the allegation licensee operates beyond the terms and conditions of the license in which Licensee allowed day care children in the off limit areas did happen. Therefore, the above allegation is determined Substantiated.

This report has been explained to the licensee and will be emailed to Licensee. Licensee has been advised to acknowledge received of reports.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021
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-20210315164957
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: KUO, WAN YU
FACILITY NUMBER: 414004693
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2021
Section Cited
CCR
102416.3(a)(6)
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102416.3 Alterations to Existing Build and Grounds.
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:(6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement is not met as evidenced by:
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Licensee agreed to hold a meeting/training with assistants to state the importance of not having day care children in off limit areas.
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Pictures and interviews obtained during investigation showed children were allowed to play in off limit areas.
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Proof of Meeting/Training should be emailed to LPA by 05/07/2021.
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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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021
LIC9099 (FAS) - (06/04)
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