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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416509
Report Date: 10/26/2022
Date Signed: 10/26/2022 11:05:02 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
10/18/2022 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221018143113
FACILITY NAME:QIU, MENGFACILITY NUMBER:
434416509
ADMINISTRATOR:MENG QIUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 689-4081
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:14CENSUS: 7DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Meng QiuTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee does not properly supervise daycare children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced initial 10-day complaint investigation to the Facility today. LPA Huang met with Licensee, Meng Qiu and explained the nature of today's visit to her.

Based on interviewed with licensee/staff, reviews child files, and LPA's own observations for the allegation listed above, LPA learned that licensee's own child was playing in the front of the house while she was working in the garage on the day that the facility was closed.

LPA concludes that the preponderance of evidence standard has been met and the allegation listed above is therefore SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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 2
Control Number 07-CC-20221018143113
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: QIU, MENG
FACILITY NUMBER: 434416509
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2022
Section Cited
CCR
102417(6)
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Operation of a Family Child Care Home: Outdoor play areas shall be either fenced, or outdoor play shall be supervised by the licensee or caregiver. This requirement is not met as evidenced by:
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Licensee to ensure that daycare children including her own child shall be supervised at all time and not play on the sidewalk or walk on the street.
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Based on licensee/staff interviews, the licensee did not comply with the section cited above for letting her own child played in front of house and walked on the street by himself which posed an immediate health, safety or personal rights risk to persons in care.
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B633 Parent Notification is required. 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.
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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: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2