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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004154
Report Date: 06/15/2022
Date Signed: 06/15/2022 05:31:50 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
04/18/2022 and conducted by Evaluator Sheran Lo
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220418145543
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: 11DATE:
06/15/2022
UNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Peifen WangTIME COMPLETED:
04:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility operating out of ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On June 15, 2022, Licensing Program Analyst (LPA), Sheran Lo conducted a subsequent complaint inspection and met with Licensee Peifen Wang to discuss the above allegation. Purpose of the inspection was explained. Present is Licensee and 2 helpers with 11 children.

During the course of the investigation, interviews were conducted with Licensee, parents, and relevant documents were gathered. Based on the interviews and relevant documents, there was no sufficient evidence to prove the facility operated out of ratio. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated.

LPA conducted exit interview with Licensee. Report and Notice of Site Visit will be emailed. Notice of Site Visit shall be posted for 30 consecutive days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
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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