<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004154
Report Date: 04/26/2022
Date Signed: 04/26/2022 04:50:18 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, 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
02/14/2022 and conducted by Evaluator Hanson Leong
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220214141937
FACILITY NAME:WANG, PEIFEN C.FACILITY NUMBER:
384004154
ADMINISTRATOR:WANG,PEIFEN C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 449-9970
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY:14CENSUS: DATE:
04/26/2022
UNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Peifen WangTIME COMPLETED:
04:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Child was injured while in care.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Leong made an unannounced inspection to deliver findings and close a complaint. LPA met with Licensee Peifen “Cynthia” Wang and explained purpose of inspection. Present at the home were the Licensee, one helper, and ten children.

During the course of the investigation, LPA Marie Rodriguez conducted interviews and reviewed records and other pertinent documents. Based on the information gathered, it was determined that the injuries received by the child were not caused by a lack of supervision on the part of the Licensee or staff but during the course of normal play and activity. It was determined these injuries were caused by unforeseeable accidents.

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 closed as UNSUBSTANTIATED.

Exit interview was conducted and report was reviewed and discussed with Licensee Peifen Wang. A copy of report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
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 3