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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004025
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:04:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2023 and conducted by Evaluator Brendon Van
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20231003084825
FACILITY NAME:SUNSHINE ADVENTURES PRESCHOOLFACILITY NUMBER:
384004025
ADMINISTRATOR:XINYU CHEN(JANICE)FACILITY TYPE:
850
ADDRESS:4837 GEARY BLVD,FIRST FLOORTELEPHONE:
(415) 699-5180
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:30CENSUS: 25DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Michelle Chen and XinYu Chen(Janice)TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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-Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
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 On November 8, 2023., Licensing Program Analyst (LPA) Van met with the site director, XinYu Chen (Janice), and owner, Michelle Chen, for this conclusion complaint inspection. The purpose of the inspection was explained. There are 25 children and five staff members present today.

During the investigation, LPA interviewed the complainant and staff members and thoroughly reviewed the records. The gathered information revealed that three teachers supervised six children during their visit to a public park on the day of the incident. While playing with a ball, one of the children missed a kick and slipped on the ball, resulting in a good-sized bruise on their head. The Center owner and Director concluded that the incident was not severe enough to necessitate an immediate report to the family or warrant a written report despite the family inquiring about the injury. The Center also felt that it was unnecessary to notify the Licensing office about the incident.
Continued on page 2...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2023 and conducted by Evaluator Brendon Van
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20231003084825

FACILITY NAME:SUNSHINE ADVENTURES PRESCHOOLFACILITY NUMBER:
384004025
ADMINISTRATOR:XINYU CHEN(JANICE)FACILITY TYPE:
850
ADDRESS:4837 GEARY BLVD,FIRST FLOORTELEPHONE:
(415) 699-5180
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:30CENSUS: 25DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Michelle Chen and XinYu Chen(Janice)TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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9
- Staff did not provide adequate supervision resulting in child sustaining multiple injuries while in care
INVESTIGATION FINDINGS:
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On November 8, 2023., Licensing Program Analyst (LPA) Van met with the site director, XinYu Chen (Janice), and owner, Michelle Chen, for this conclusion complaint inspection. The purpose of the inspection was explained. There are 25 children, and five staff members present today.

As part of the investigation, the LPA conducted interviews with the complainant and staff members and carefully examined the records. The information gathered during the investigation revealed that six children were supervised by three teachers during their visit to a public park on the day of the incident. While playing with a ball, one of the children missed a kick and fell, sustaining a good-sized bruise on their head. The staff members who witnessed the incident promptly attended to the child.

The Department has investigated the above allegation. 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 allegations are Unsubstantiated.

An exit inspection was conducted with the owner, Michelle Chen. A copy of the report was provided to the owner, Michelle Chen at the conclusion of the inspection. LPA informed the Owner that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 05-CC-20231003084825
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SUNSHINE ADVENTURES PRESCHOOL
FACILITY NUMBER: 384004025
VISIT DATE: 11/08/2023
NARRATIVE
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Based on the Department's investigation, the preponderance of evidence standard has been met. Therefore, the above allegation(s) is found to be substantiated. The Center failed to report a child’s injury to Community Care Licensing within 24 hours of the incident by phone or fax and submit the unusual incident report. LIC 624 by mail within seven days. In addition, the Center failed to adhere to its Plan of Operation regarding injury reporting. As a result, the California Code of Regulations (Title 22, Div 12 Chp1) is being cited on the attached LIC9099d. See the next page for two Type B citations.

A copy of today’s report, appeal rights, and the site visit notice were given to the owner, Michelle Chen. A notice of site visit must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with the owner.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 05-CC-20231003084825
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SUNSHINE ADVENTURES PRESCHOOL
FACILITY NUMBER: 384004025
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
Section Cited
CCR
101212(d)(1)
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101212(d) Reporting Requirement: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made
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The Center will have all staff members trained on reporting incidents accordingly. Once the training is complete, all the materials and participants will be provided to the Licensing Office for review. The facility will ensure that the training is completed by the due date.
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This requirement was not met, as evidenced by interviews and records review. It has been found that the Center failed to meet the requirement of reporting a head injury to the family and Licensing Office. The Center's failure to report the injury could pose a potential health and safety risk to children in care.
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Type B
11/17/2023
Section Cited
CCR
101173(d)
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101173 The child care center shall operate in accordance with the terms specified in the plan of operation. (d)The child care center shall operate in accordance with the terms specified in the plan of operation.
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The center must commit to and adhere to its operational plan at all times, which includes promptly reporting any accidents or injuries to the families involved.
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This requirement was not met, as evidenced by the record review. The Center failed to adhere to the parents’ handbook, which indicated that an injury that a child sustained at the Center would warrant an immediate report to the family. Not following the Center’s plan of operation poses a potential health and safety risk to children 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: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4