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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416300
Report Date: 05/07/2025
Date Signed: 05/12/2025 09:08:30 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
03/05/2025 and conducted by Evaluator Linke Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250305131033
FACILITY NAME:WANG, WEIFACILITY NUMBER:
434416300
ADMINISTRATOR:WEI WANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 378-7178
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY:14CENSUS: 10DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Wang, Wei TIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Criminal Record Clearance-Uncleared adult providing care and supervision to daycare children.
Other-Adult providing care to children does not have proof of immunization.
INVESTIGATION FINDINGS:
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On 05/07/2025 at 11:00 AM, Licensing Program Analyst (LPA) Kate Huang conducted an unannounced complaint visit to deliver the investigation findings regarding the above allegations. LPA met with the licensee, Wei Wang, and explained the purpose of the visit.

During the entire investigation, LPA reviewed staff records and interviewed the licensee, staff, parents, and the involved individual. The licensee, staff, and involved individual all stated that the individual assisted at the facility twice as a "trial-out" teacher, spending one hour at the facility each day. They confirmed that the individual was supervised by the licensee at all times and was never left alone with the children. The licensee explained that she did not request fingerprint clearance because she believed the involved individual was working here only as a "trial-out" teacher. The licensee stated that she intended to assess the individual's performance before deciding whether to hire her.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
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 07-CC-20250305131033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WANG, WEI
FACILITY NUMBER: 434416300
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2025
Section Cited
HSC
1597.622(a)(1)
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§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee to submit a plan of correction by the POC Due Date.
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This requirement is not met as evidenced by:
Based on interview and records review, licensee cannot provide the involved individual's immunization record and did not request the individual's immunization records.
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Type B
05/16/2025
Section Cited
HSC
1596.871(b)(1)
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§1596.871 Fingerprints and criminal record information of individuals in contact with child day care facility clients; exemptions; criminal records clearances(b) (1) In addition to the applicant, this section shall be applicable to criminal record clearances and exemptions for the following persons:
(A) Adults responsible for administration or direct supervision of staff.
(B) Any person, other than a child, residing in the facility.
(C) Any person who provides care and supervision to the children.
(D) Any staff person, volunteer, or employee who has contact with the children.
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Licensee to submit a plan of correction by the POC Due Date.
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This requirement is not met as evidenced by:
Based on interview and records review, the involved individual who provided care and supervision to the children did not have fingerprint clearance.
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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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20250305131033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: WANG, WEI
FACILITY NUMBER: 434416300
VISIT DATE: 05/07/2025
NARRATIVE
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Regarding the involved individual’s immunization records, LPA reviewed the staff records but was unable to locate any immunization records for her. The licensee stated that immunization records were neither requested nor checked, and she did not inquire about them. The licensee explained that she believed the individual may have already met the requirements, as the individual had previously assisted at other facilities.

Based on the available evidence, the preponderance of evidence standard has been met; therefore, the above allegations are substantiated.

An exit interview was conducted. The report was reviewed and discussed with Licensee Wei Wang in Mandarin. A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3