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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423119
Report Date: 06/05/2024
Date Signed: 06/05/2024 12:01:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2024 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20240403170256
FACILITY NAME:SHU REN INTERNATIONAL SCHOOLFACILITY NUMBER:
013423119
ADMINISTRATOR:CHEN, CHIEN-HSUANFACILITY TYPE:
850
ADDRESS:2125 JEFFERSON AVENUETELEPHONE:
(510) 841-8899
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:104CENSUS: 71DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Chien-Hsuan ChenTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
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9
Facility is operating out of ratio.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
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9
10
11
12
13
Licensing Program Analyst (LPA) Cherie Acosta and Dealia Frison conducted an unannounced visit to investigate the above allegation.

During the visit LPAs conducted interviews and reviewed files.
It was reported by another party that the facility was operating out of ratio. Based on interviews conducted and file review LPAs are not able to prove or disprove if the facility has operated out of ratio.
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 deemed unsubstantiated.
Exit interview and report reviewed with Chien-Hsuan Chen.
Notice of Site visit was provided and must be posted for 30 days.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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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