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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416263
Report Date: 02/01/2022
Date Signed: 02/01/2022 10:23:42 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/20/2021 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20211220094547
FACILITY NAME:BI, XIAOWENFACILITY NUMBER:
434416263
ADMINISTRATOR:XIAOWEN BIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 508-0471
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:14CENSUS: 0DATE:
02/01/2022
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Xiaowen BiTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not present in the home the appropriate amount of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced continue complainting visit to the Facility today. LPA Huang met with licensee, Xiaowen Bi and explained the nature of today's visit to her. LPA observed no children in the facility.

Based on interviews with complainant, licensee, licensee's mother, parent of child in care, reviews child files, and LPA's own observations for the complaint listed above, it could not be proved or disproved.

LPA therefore concludes that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

NO DEFICIENCY WAS CITED. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
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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