434416353-5-17-2023-07-CC-DSTN-CS7VPX-20230526163725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434416353
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:18:35 PM

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
03/23/2023 and conducted by Evaluator Janette Cruz

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230323141034

FACILITY NAME:	ZHOU, XIN		FACILITY NUMBER:	434416353
ADMINISTRATOR:	ZHOU, XIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 990-4564
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95120
CAPACITY:	14	CENSUS: 10	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	02:34 PM
MET WITH:	Xin Zhou		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Provider yells at children in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janette Cruz and Licensing Program Manager (LPM) Diana Stephenson conducted an unannounced follow up complaint investigation and met with Xin Zhou, Licensee. Purpose of today's follow up complaint investigation: deliver investigation findings. LPA and LPM observed 10 daycare children (three infants and seven preschoolers) and Licensee's spouse, Han Zhang, present in the home during today's inspection.

The investigation of allegation listed above was conducted by LPA Cruz. Based on the available evidence including observations, record reviews and interviews completed for this complaint investigation, it is concluded that although the allegation noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

Exit interview conducted with Licensee, Xin Zhou. Appeal rights were discussed.
Notice of Site Visit was issued and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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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