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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416716
Report Date: 02/24/2025
Date Signed: 02/24/2025 04:48:33 PM

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
12/05/2024 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20241205182918
FACILITY NAME:ZHANG, SIJIAFACILITY NUMBER:
434416716
ADMINISTRATOR:ZHANG, SIJIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 981-4915
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:14CENSUS: 10DATE:
02/24/2025
UNANNOUNCEDTIME BEGAN:
04:07 PM
MET WITH:Sijia ZhangTIME COMPLETED:
04:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to administer CPR on a child who was choking
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marilou Monico met with Licensee, Sijia Zhang, for an unannounced follow up complaint investigation. The purpose of today's inspection was explained with Sijia.

Based on interviews and reports obtained from the Santa Clara County Fire Department, the above allegation is found to be UNSUBSTANTIATED, meaning although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

As a result of this inspection, there were no deficiencies issued. Exit interview conducted and report was reviewed with Licensee, Sijia Zhang.

A Notice of Site Visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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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