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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417299
Report Date: 08/13/2025
Date Signed: 08/13/2025 11:05:14 AM

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
07/30/2025 and conducted by Evaluator Linke Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250730130229
FACILITY NAME:CHEN, XINFACILITY NUMBER:
434417299
ADMINISTRATOR:CHEN, XINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 885-6486
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:14CENSUS: 10DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Chen, XinTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee is operating over capacity
Licensee is operating over ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kate Huang and Licensing Program Manager (LPM) Gladys Kuizon conducted an unannounced complaint visit to deliver investigation findings regarding the above allegations. Upon arrival, one staff -Wanjun Gao (S1) opened the door and licensee was absent. After beeing contacted, licensee arrived about 10 minutes later. LPA and LPM explained the purpose of the visit.

Upon arrival, 6 children including 4 infants were present with S1 supervising all children. After licensee returned and more children arrived, a total of 10 children (4 infants and 6 preschool-age) were present.

Additionally, when the LPA conducted an unannounced inspection of the facility on 08/01/2025, upon arrival, the licensee was also not present. S1 was supervising nine children, including four infants, during naptime. Licensee returned after being contacted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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 3
Control Number 07-CC-20250730130229
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: CHEN, XIN
FACILITY NUMBER: 434417299
VISIT DATE: 08/13/2025
NARRATIVE
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Although this facility is licensed as a Large Family Child Care Home, CCR Title 22, Section 102416.5 requires that if only one adult attendant is present, the licensee must comply with the capacity and ratio limits for a Small Family Child Care Home. In such cases, the total capacity may not exceed eight children. If caring for up to six children, no more than three may be infant.

Based on LPA’s observation, records review, and interviews conducted, the preponderance of evidence standard has been met and therefore the above allegations are Substantiated.

LPM and LPA informed licensee that this report dated on 08/13/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPM and LPA informed the licensee to provide a copy of this licensing report dated on 08/13/2025 that document one Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted, where the report was reviewed and discussed with Licensee Chen, Xin in Mandarin. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20250730130229
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: CHEN, XIN
FACILITY NUMBER: 434417299
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2025
Section Cited
CCR
102416.5(e)
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102416.5 Staffing Ratio and Capacity (e)
If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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Licensee to provide a plan of correction by the POC due date to ensure compliance with capacity and ratio regulations at all times.
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This requirement was not met as evidenced by: When the LPA visited the facility on 08/01/2025, the licensee was not present upon arrival. Only one adult attendant, who had not completed fingerprint clearance at that time, was supervising nine children which posed a immediate risk to the health and safety of the children 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: Linke Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3