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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004254
Report Date: 08/19/2021
Date Signed: 08/19/2021 10:58:51 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, 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
06/10/2021 and conducted by Evaluator Brendon Van
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210610091153
FACILITY NAME:LI, SHUNAFACILITY NUMBER:
384004254
ADMINISTRATOR:LI,SHUNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 988-5799
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY:14CENSUS: 3DATE:
08/19/2021
ANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Li ShunaTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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-Facility is operating over infants' capacity.
INVESTIGATION FINDINGS:
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On August 19, 2021, at 9:45 AM, Licensing Program Analysts (LPAs) Van and Ly (a certified Cantonese Analyst) conducted a subsequent complaint inspection to deliver the above allegation findings. LPAs met with the Licensee, Li Shuna. The purpose of the inspection was explained, and the Licensee granted LPAs access to the home. Due to the Licensee's limited English, LPA Ly was assisting with the translation. There were three children in care, one infant, and two preschoolers with a helper.

On June 17, 2021, during the initial open of the complaint inspection, LPA obtained a children roster from the Licensee. According to the children roster, the Licensee has 13 children in enrollment. Among the 13 children, 9 are infants. On the subsequent complaint visit on July 27, 2021, LPAs requested the names of children attending the Licensee's daycare from June 14 – June 25, 2021. Two weeks later, the Licensee informed LPAs that she could not remember which families were attending the daycare during that two weeks.
Continued on the next page...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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
Control Number 05-CC-20210610091153
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LI, SHUNA
FACILITY NUMBER: 384004254
VISIT DATE: 08/19/2021
NARRATIVE
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As part of the complaint investigation, parents were interviewed. Based on interviews and records reviewed, the Licensee had more than six infants in care on multiple days in the month of June and July 2021. As a result, the preponderance of evidence standard has been met. Therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12 & Chapter 3), Type A is cited on the attached LIC 9099D.") The Licensee is informed to provide a copy of the Complaint Investigation Report and the Type "A" Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report and appeal rights were provided and reviewed with the Licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.

The report was reviewed and signed by the Licensee, Li Shuna. An exit interview was conducted, and rights to comment were discussed with the Licensee. Today's report, 8/19/2021, and notice of site visit will be sent to the Licensee email by the close of business on 8/19/21. Confirmation of receipt is required.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20210610091153
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: LI, SHUNA
FACILITY NUMBER: 384004254
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/20/2021
Section Cited
CCR
102416.5(d)(1)
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102416.5 Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the Licensee's home and the assistant provider's children under age 10, shall be either:(1) Twelve children, no more than four of whom may be infants; or
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The Licensee needs to maintain the capacity specified on the License and followed the maximum number of children for whom care can be provided. The capacity must be reduced immediately. The Licensee stated that the part-time children infants would be dis-enrolled, and she would maintain a record of all infants' attendance schedules.
The facility needs to correct this deficiency by the due date, 8/20/2021. Failure to correct the deficiency by the due date will result in a civil penalty.

Licensed capacity; Max 12 children, with no more than 4 infants children. Or max capacity 14, with no more than 3 infants and 2 school-age children. A follow-up visit will be conducted for correction.
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This requirement is not met, as evidenced by records reviewed and interviews. The Licensee failed to follow the infants' capacity requirement specified on the License. On certain days in the month of June and July, the Licensee had more than six infants in care, which poses an immediate health and safety risk to the children in care.
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An Informal meeting or Non-compliance Office visit will be scheduled.
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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: 08/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3