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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416348
Report Date: 06/11/2024
Date Signed: 06/11/2024 09:49:20 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
03/13/2024 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240313112817
FACILITY NAME:BAI, XIAOFACILITY NUMBER:
434416348
ADMINISTRATOR:BAI, XIAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 888-1302
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY:14CENSUS: 11DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Xiao BaiTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Conduct of inimical-adult in the home poses a risk to children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced subsequent inspection to the facility to deliver finding on above allegation. LPA met with Licensee, Xiao Bai and explained the nature of today’s inspection to her.

The investigation was conducted by IB Special Investigator, Rhonda Austin. Based on interviews conducted with licensee, staff, daycare parents, and other implicated persons, and information obtained: Licensee's husband was arrested for arson by lighting a pillow on fire at the daycare home. He admitted to police officers that he was using methamphetamines and the licensee reported her husband was using methamphetamines. Santa Clara County Deputy District Attorney (DDA) Walton stated in her experience, drug users are “dangerous.”

Continue to next page LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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 7
Control Number 07-CC-20240313112817
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: BAI, XIAO
FACILITY NUMBER: 434416348
VISIT DATE: 06/11/2024
NARRATIVE
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Continue from LIC 9099 -

IB Investigator concludes that based on confidential interviews and information obtained and reviewed, 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, Chapter 3), are being cited on the attached LIC 9099-D.

Licensee was informed that civil penalties may be assessed by the department determined that any violation resulted into injury of a person in care, and/or failure to correct the deficiency.

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, obtain the signature of parents in care with form LIC 9224 and keep in the child's file.

A type A deficiency was cited. A notice of site visit was given and must remain posted for 30 days. The report was discussed and verbally translated into Chinese during the exit interview with Licensee, Xiao Bai.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
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
03/13/2024 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240313112817

FACILITY NAME:BAI, XIAOFACILITY NUMBER:
434416348
ADMINISTRATOR:BAI, XIAOFACILITY TYPE:
810
ADDRESS:3907 MARLETTE DRIVETELEPHONE:
(408) 888-1302
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY:12CENSUS: 11DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Xiao BaiTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Conduct Inimical-adult was under the influence of methamphetamines at the daycare home while children were present.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced subsequent inspection to the facility to deliver finding on above allegation. LPA met with Licensee, Xiao Bai and explained the nature of today’s inspection to her.

The investigation was conducted by IB Special Investigator, Rhonda Austin. Based on interviews conducted with licensee, staff, daycare parents, and other implicated persons, and information obtained: Although subject licensee's husband admitted he was under the influence of methamphetamines to police officers who responded to the arson, the incident happened on a Sunday (03/10/2024) when no daycare children were in care. Staff reported not seeing drugs or he was using drugs at the facility. Staff did not notice he being under the influence of a controlled substance. Licensee's husband did not provide care for the children and was not typically around the daycare children.

Continue to next page LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 07-CC-20240313112817
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: BAI, XIAO
FACILITY NUMBER: 434416348
VISIT DATE: 06/11/2024
NARRATIVE
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Continue from LIC 9099 -A

IB Investigator concludes that based on confidential interviews and information obtained and reviewed, 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 07-CC-20240313112817
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: BAI, XIAO
FACILITY NUMBER: 434416348
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/11/2024
Section Cited
CCR
102402(a)(3)
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Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.
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Licensee to ensure and to submit a POC written statement to the office that she is abiding a no-contact order issued by the court on her husband that applies both to the daycare provider Mrs. Bai as well as the address of the home/daycare ( which means the defendant shall not contact licensee or go to the home/daycare).
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This requirement was not met as evidenced by as evidenced by licensee's husband was arrested for arson by lighting a pillow on fire at the daycare home and using methamphetamines. This posed an immediate risk to the health and safety of 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, obtain the signature of parents in care with form LIC 9224 and keep in the child's file.
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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: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7