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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416346
Report Date: 10/08/2024
Date Signed: 10/08/2024 04:59:08 PM

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
10/03/2024 and conducted by Evaluator Mandeep Kaur
COMPLAINT CONTROL NUMBER: 07-CC-20241003153758
FACILITY NAME:ZHANG, ZHIFENGFACILITY NUMBER:
434416346
ADMINISTRATOR:ZHANG, ZHIFENGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 992-1037
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:14CENSUS: 10DATE:
10/08/2024
UNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Zhifeng ZhangTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Criminal Record Clearance - Employees have no criminal background clearances.
Other - Licensee does not verify required staff vaccinations/health screening
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Mandeep Kaur and Linke "Kate" Huang conducted an unannounced complaint investigation. LPAs met with Licensee, Zhifeng Zhang and discussed the complaint allegations with them. LPA Kate assisted with translation to Mandarin. Upon arrival, LPAs observed 8 children present in the day care living room area with a staff (S1). LPAs toured the indoor and outdoor areas of the Facility with licensee. LPAs observed two infants were taking nap in a bedroom with staff (S2).

LPAs interviewed licensee, and two staff(S1 & S2) during today's investigation.

Licensee self admitted that two staff (S1 & S3) has not obtained the criminal record clearance and Staff (S1) is present with children during today's investigation. Licensee self admitted that three staff (S1, S2, & S3) do not have their records files available at the facility for review including immunizations records.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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 4
Control Number 07-CC-20241003153758
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: ZHANG, ZHIFENG
FACILITY NUMBER: 434416346
VISIT DATE: 10/08/2024
NARRATIVE
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Based on observations, records review, and interviews during the investigation process, the Department concludes that two staff (S1 & S3) is providing care to the children and have no criminal background clearances and three out of three staff (S1,S2, & S3) do not have required staff vaccinations/health screening on file. Therefore, the above allegations are SUBSTANTIATED, meaning the allegations are valid because the preponderance of the evidence standard has been met.

A Type A deficiency and A Type B deficiency is being cited on the attached LIC 9099D forms and civil penalty shall be assessed in the total amount of $700.

Appeal rights given and exit interview conducted with Licensee, Zhifeng Zhang.

A Notice of Site Visit was given to Zhifeng Zhang. Notice of Site Visit along with a copy of today's report dated (10/08/2024) and the Type A citation shall remain posted in a visible location of the Facility for 30 consecutive days.

LPAs also informed the Licensee that they must provide a copy of this licensing report dated (10/08/2024) that documents today's Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the child(ren) are in care, and to any newly enrolled parents/guardians
for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report(LIC
9224) must be placed in the child's file.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20241003153758
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: ZHANG, ZHIFENG
FACILITY NUMBER: 434416346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/09/2024
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance:(d)All individuals subject to a criminal record review pursuant to Health and Safety
Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department...
This requirement was not met as evidenced by:
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 Licensee has agreed to not have any one without the fingerprint clearance to work around the children in home. Licensee has agreed to submit the written plan to not have any adult staff work around children without the fingerprint clearance by POC due date to the department. Licensee has agreed to provide the copy of the fingerprint clearance for staff (S1 & S3) to the Department prior to two staff (S1 & S3) would start working with the children in the home.
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Based on observations, interviews and records review, the licensee did not ensure a criminal record clearance was obtained for two staff (S1 & S3) in the home while the children are present, which poses an immediate Health, Safety, or Personal Rights risk to persons 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: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 07-CC-20241003153758
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: ZHANG, ZHIFENG
FACILITY NUMBER: 434416346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/22/2024
Section Cited
HSC
1596.7995(a)(1)
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Employees or volunteers at day care center; immunization requirements; records; exemptions: (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
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Licensee agreed to submit the proof of the immunization records inlcuding TB test records for staff (S1, S2, and S3) by POC due date to the department.
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Based on interviews, the licensee did not comply with the section cited above for three staff (S1, S2 and S3) which poses a potential health, safety or personal rights risk to persons 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: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4