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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434411007
Report Date: 12/05/2024
Date Signed: 12/05/2024 10:56:30 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2024 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20241122141945
FACILITY NAME:YU, ZHIDONGFACILITY NUMBER:
434411007
ADMINISTRATOR:YU, ZHIDONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 505-9859
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:14CENSUS: 9DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Zhidong YuTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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1. Licensee did not provide parents required licensing reports.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Anna Morales and Shine Yu conducted a Subsequent Complaint visit to deliver the findings for the above allegation. LPA's were greeted by Licensee Zhidong Yu.

On 11/25/24, LPA's Anna Morales and ShinenYu conducted a initial complaint investigation and reviewed supporting documentation. LPA's reviewed 11 children's files and observed copies with parents/guardian's signatures on the LIC9224(Acknowledgment of Receipt of Licensing Reports) in each of the children's files for TYPE A Citation(s) given on 11/1/24.
On 12/2/24, and on 12/3/24 interviews were conducted with parents. Parents stated that they were verbally informed of one Type A citation given on 11/1/24 for being over ratio/capacity. Parents stated they were not informed of a second Type A citation for Criminal Record Clearance issued on the same date (11/1/24).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 3
Control Number 07-CC-20241122141945
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: YU, ZHIDONG
FACILITY NUMBER: 434411007
VISIT DATE: 12/05/2024
NARRATIVE
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Parents, also, stated that they were not given copies of the Licensing Reports issued on 11/1/24, but signed a form, LIC9224(Acknowledgment of Receipt of Licensing Reports).

Based on the interviews conducted, the Licensee did not provide parents/guardians required licensing reports. Parents were only verbally informed of one Type A citation given on November 1,2024 for ratio/capacity.

Based on LPA’s interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on the next page. Licensee was informed that failure to correct the deficiencies may result in civil penalties.

Appeal Rights were given.

NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20241122141945
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: YU, ZHIDONG
FACILITY NUMBER: 434411007
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2024
Section Cited
HSC
1596.8595(c)(1)
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§1596.8595(c)(1):A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety,or personal rights of children in care
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Licensee will ensure that all of the all of the parents/guardians will receive copies of the reports with the TYPE A citations that were issued on 11/1/24,
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This requirement was not met by evidence by: Licensee failed to give copies of the Licensing Reports with TYPE A citations, and failed to notify parents/ guardians of one TYPE A citation pertaining to Criminal Record Clearance that were issued by CCL on 11/1/24, which poses a potential health, safety or personal rights risk to persons in care.
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and Licensee will submit copy of parents/guardians signatures acknowledging receiving the copies of the Licensing Reports (11/1/24)by the POC date. Licensee will,also,submit a plan that she will ensure that she will comply with AB633 requirements.
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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: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3