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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434407732
Report Date: 10/29/2019
Date Signed: 10/29/2019 03:59:27 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2019 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20190819165045
FACILITY NAME:JAN, MAAN MEYFACILITY NUMBER:
434407732
ADMINISTRATOR:JAN, MAAN MEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 300-5997
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY:14CENSUS: 6DATE:
10/29/2019
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Maan Mey Jan & Chuan "Carol" XiaoTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Provider denied parent entry into the facility

Day care child sustained an unexplained injury
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Mel Matos and Dung Mac met with Maan Mey Jan, Licensee, & Chuan "Carol" Xiao, adult assistant, for an unannounced complaint investigation inspection. Purpose of today's inspection: deliver investigation findings.
LPAs also observed one additional adult assistant (Jie Fang "Kelly" Liu), and six day care children (3 infants & 3 preschool) in the home during today's inspection. LPA Matos interviewed Maan Mey Jan, Licensee, staff, random sampling of day care parents, and reviewed documents for this investigation of the two allegations listed on this complaint. In concluding the investigation, LPA Matos concludes that although the allegations noted on this complaint (provider denied parent entry into the facility and 2) day care child sustained an unexplained injury, may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus unsubstantiated.

There are no deficiencies cited as a result of today's inspection.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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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