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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416344
Report Date: 11/21/2022
Date Signed: 12/06/2022 11:31:16 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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
11/16/2022 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221116121202
FACILITY NAME:MA, JIEFACILITY NUMBER:
434416344
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jie MaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee operated beyond the terms of the license.
INVESTIGATION FINDINGS:
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* The amend is to correct from the original that the facility representitive signature was missing.
Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced initial 10-day complaint investigation to the Facility. LPA Huang met with Licensee, Jie Ma and explained the nature of today's visit to her.
LPA observed the facility was operating over infant ratio with 4 infants, 1 preschooler, and her school-age daughter.
LPA Huang interviewed licensee, an assistant and obtained copies of pertinent information.
Based on LPA’s observations, records reviewed, and 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/Director was informed that failure to correct the deficiencies may result in civil penalties.

AB633 Parent Notification is required. This page (LIC9099) along with LIC9099-D page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
A notice of site visit was issued and posted near the facility entrance along with the Type "A" deficiency and must remain posted for 30 consecutive days.

The report was discussed and verbally translated into Chinese during the exit interview with Licensee, Jie Ma.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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 07-CC-20221116121202
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MA, JIE
FACILITY NUMBER: 434416344
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/30/2022
Section Cited
CCR
102416.5(b)(2)
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Staffing Ratio and Capacity: (b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants;
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Licensee needs to immediately reduce the number of infants in care, no more than 3 infants, if also care other children above two years old. Licensee needs to submit CCL a written statement indicating what steps the Licensee is going to implement to ensure that she is operating within the required capacity of her Small Family Child Care License by the POC due date.
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This requirement was not met as evidenced by: LPA observed there were 6 children (4 infants, 1 preschooler & 1 school-age child) in care during the time of inspection. This poses an immediately safety & health risk to children in care.
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According to AB 633, all parents of children currently enrolled and any future children being enrolled for the next 12 months must be provided with this report which contains this Type A deficiency.
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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: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2