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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313623424
Report Date: 07/14/2022
Date Signed: 07/14/2022 11:01:05 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/06/2022 and conducted by Evaluator Jeremey McClain
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220706164153
FACILITY NAME:LI, MIAOMIAOFACILITY NUMBER:
313623424
ADMINISTRATOR:LI, MIAOMIAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 508-5160
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:14CENSUS: 9DATE:
07/14/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Miaomiao LiTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Licensee Administered a Covid Test to a child in care without the parents Consent
INVESTIGATION FINDINGS:
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On July 14th, 2022, at 9 am, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Miaomiao Li for the purpose of a complaint investigation. Licensee’s assistant was present and providing care for nine children, which included two infants.
LPA investigated allegations that the Licensee administered a home Covid-19 test kit to child in care without their parents’ consent. During today’s investigation, LPA conducted an interview with the licensee, and reviewed a child’s file. made observations at the facility/home, and reviewed files. Evidence is conclusive that on July 6th, 2022, Licensee administered a Covid-19 home test kit to a child in care, without their parent’s consent. The preponderance of evidence standard has been met; therefore, the allegation is determined to be substantiated.
Title 22 deficiencies are cited on the subsequent page of this report and pose a potential threat to the health and safety of children in care if not corrected. LPA provided licensee with Appeal Rights, and an exit interview was conducted. A Notice of Site Visit was posted and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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 2
Control Number 03-CC-20220706164153
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LI, MIAOMIAO
FACILITY NUMBER: 313623424
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2022
Section Cited
CCR
102423(a)(2)
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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:(2)To receive safe, healthful, and comfortable accommodations,
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Licensee understands that she should have parent's permission if she feels it is necessary to administer a home Covid-19 test kit to children in care.
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furnishings, and equipment. This requirement was not met as evidenced by interviews with the Licnesee. Licensee stated that on July 6th, 2022, she administered a home Covid-19 test to a child in care, without their parent's consent. This is a potential risk to the health and safety of children in care if not corrected.
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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: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2