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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004755
Report Date: 10/10/2024
Date Signed: 10/10/2024 05:57:58 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
10/09/2024 and conducted by Evaluator Man Tso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20241009131739
FACILITY NAME:SHU, CHUNHUAFACILITY NUMBER:
384004755
ADMINISTRATOR:SHU, CHUNHUAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 676-8718
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY:14CENSUS: 5DATE:
10/10/2024
UNANNOUNCEDTIME BEGAN:
04:32 PM
MET WITH:Xiuhong Huang / Chunhua ShuTIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Over capacity for number of infants in care
INVESTIGATION FINDINGS:
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On October 10, 2024, at approximately 4:10 PM, Licensing Program Analyst (LPA), Tso made an unannounced complaint investigation and met with the licensee’s helper, Xiuhong Huang. The licensee, Chunhua Shu was not at the facility and arrived the facility at 4.51pm. Purpose of the visit was explained. Present in the facility is 2 helpers, and 5 infants.

Based on LPAs’ gathered information through observation, interviews and records reviews, the agency has investigated the complaint allegation above, overcapacity for number of infants in care. Per the licensee, she admitted that the facility operated overcapacity.

The facility failed to comply with the Staffing Ratio and Capacity regulations. The preponderance of evidence standard has been met. The above allegation is found to be SUBSTANTIATED. A Type A violation was issued today, October 10, 2024 in accordance with the California Code of Regulations, Title 22, Division 12, citation is being cited on the attached LIC 9099D.

This report and appeal rights had been discussed and reviewed with the licensee whose signature confirmed have read the report and received the report and appeal rights. The Facility is advised 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 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 will be maintained in the facility file and made available for public review three years after the thirty-day posting requirement has been met.

Exit interview conducted and report was reviewed with the licensee, Chunhua Shu. This report and a notice of site visit was given to the licensee and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
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 05-CC-20241009131739
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SHU, CHUNHUA
FACILITY NUMBER: 384004755
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2024
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;

This requirement is not met, as evidenced by:
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Licensee will lower her total enrollment to required 4 infants or arrange the infant’s attendance within the licensed capacity by the due date: 10/11/2024. Updated children schedule and/or children's roster will be submitted to the department via email.

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At 4:20PM, on 10/10/24, based on record review, interview and observations, LPA confirmed licensee is operating over capacity with 5 infants in care, which poses an immediate immediate health, safety, or personal rights 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: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2