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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416359
Report Date: 11/28/2023
Date Signed: 11/30/2023 03:39:17 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
08/14/2023 and conducted by Evaluator Sheena Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230814100916
FACILITY NAME:WANG, YANGFACILITY NUMBER:
434416359
ADMINISTRATOR:WANG, YANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 252-0397
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 6DATE:
11/28/2023
UNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Yang WangTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Staff did not seek immediate medical attention to day care child.
INVESTIGATION FINDINGS:
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Page 1
Licensing Program Analysts (LPAs) Sheena Chin and Doni Fici and Licensing Program Manager (LPM) Gladys Kuizon conducted a unannounced complaint visit and met with the licensee, Yang Wang, today. The purpose of LPA’s visit was to deliver the investigation findings. Present during today’s visit were the licensee, 2 teachers, one helper and 6 kids in care during today's inspection.

During investigations, LPA Oscar Huang gathered documents from the facility and Investigation Branch (IB) conducted several interviews with parents, staff, and the licensee. IB also reviewed medical report. Medical documents and statements of daycare staff and victim’s parent indicate that the child’s nose injury was significant and presented signs of bruising and swelling. Daycare staff did not call emergency medical staff to do an evaluation of the child’s head injury, nor did they attempt to contact the parent by phone to notify them of the child’s injury. Instead, they waited for the parent to pick up the child before notifying them
continue to page 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
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 5
Control Number 07-CC-20230814100916
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: WANG, YANG
FACILITY NUMBER: 434416359
VISIT DATE: 11/28/2023
NARRATIVE
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Page 2.

Based on the information obtained and interviews, the preponderance of evidence standard has been met, therefore the allegation of “Neglect/Lack of Care and Supervision, resulted in daycare staff failing to seek immediate medical attention for daycare child.“ is found to be SUBSTANTIATED.

Deficiency was cited today.

Exit interview was conducted in Mandarin. This report, the appeal rights, and notice of site visit were provided to licensee today.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20230814100916
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: WANG, YANG
FACILITY NUMBER: 434416359
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/29/2023
Section Cited
CCR
102423(a)(2)
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Personal Rights 102423(a)(2). To receive safe, healthful, and comfortable accommodation, furnishings and equipment.
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The licensee will send LPA a plan to prevent such things from happening again.
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The requirement was not met. Licensee and facility staff did not seek immediate medical attention for child’s head injury even upon observation of bruising and swelling in facial area, which poses an immediate risk to the safety and health of child 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: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5