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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416348
Report Date: 01/31/2025
Date Signed: 01/31/2025 10:01:21 AM

Unsubstantiated


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
12/30/2024 and conducted by Evaluator Linke Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20241230091311

FACILITY NAME:BAI, XIAOFACILITY NUMBER:
434416348
ADMINISTRATOR:BAI, XIAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 888-1302
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY:14CENSUS: 4DATE:
01/31/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Bai, XiaoTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
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9
Licensee allowed uncleared staff to work in facility.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Kate Huang and Licensing Program Manager (LPM) Gladys Kuizon conducted a unannounced complaint visit and met with licensee, Bai, Xiao today. The purpose of LPA’s visit was to deliver investigation findings.

On 01/08/2025 and 01/31/2025, LPA and LPM arrived unannounced at the facility and toured the facility, observed all staff present have fingerprint clearance associated with the facility. The reporting party (RP) alleged that there are employees who have worked at the facility without a background check. RP did not provide names of employees. LPA contacted parents by phone and conducted interviews. Most of parents do not know teachers names.

This agency has investigated the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted, where the report was reviewed and discussed with licensee Xiao Bai in Mandarin. A notice of site visit has been issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
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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