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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344500802
Report Date: 06/16/2023
Date Signed: 06/16/2023 04:19:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2023 and conducted by Evaluator Corina Beckby
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230615133258
FACILITY NAME:XIONG, DANFACILITY NUMBER:
344500802
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
06/16/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Dan XiongTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility is operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Corina Beckby met with Licensee Dan Xiong to open and close a complaint investigation, regarding the above allegation. Upon arrival, LPA observed Licensee and 1 adult supervising 8 daycare children (including 2 infants). LPA made observation, inspected the areas accessible to children, interviewed Licensee and reviewed documents. Based on the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED.

Title 22 deficiency is cited on the subsequent page of this report. Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensee. LIC 9224 and Appeal Rights were provided. An exit interview was conducted, and a Notice of Site Visit posted which must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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 53-CC-20230615133258
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: XIONG, DAN
FACILITY NUMBER: 344500802
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2023
Section Cited
CCR
102416.6(b)(3)
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(b)For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time...shall be one of the following(3) More than six and up to eight children...only if the criteria in Section 1597.44 of the Health and Safety Code are met.:
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Licensee will show proof of disenrolled families to comply with regulations by POC, LPA will return to ensure compliance.
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This requirement is not met as evidenced by: Based on observation and file review, the licensee did not comply with the section cited above, caring for 8 preschool children (2 being infants), which poses an immediatel health, safety or personal rights risk to persons in care.
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2