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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004755
Report Date: 11/01/2024
Date Signed: 11/01/2024 03:26:00 PM

Unsubstantiated


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: 3DATE:
11/01/2024
UNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Chunhua ShuTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
To provide care to the children at the off-limit area
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 01, 2024, at approximately 2.10PM, Licensing Program Analyst (LPA) Tso conducted an unannounced visit for delivery of the complaint investigation findings and met with the licensee’s helper, Xiuhong Huang. The licensee, Chunhua Shu was not at the facility and arrived at the facility at 2.47PM. LPA explained the purpose of the inspection and were granted entry to the facility by the licensee’s helper. Present, the licensee’s helper is supervising 3 infants.

Based on information obtained during the course of this investigation through observations, interviews and records review, there was no sufficient evidence to prove that the allegation listed above, occurred. 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.

Exit interview conducted and this report was reviewed with the Licensee whose signature confirm have read the report. Report must be made available for public review upon request. A copy of this report and appeal rights have been discussed and left with Licensee. Notice of Site Visit shall remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
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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