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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435700339
Report Date: 07/28/2022
Date Signed: 07/28/2022 12:33:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/19/2022 and conducted by Evaluator Christina Uribe
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220719121932
FACILITY NAME:FAN, SITINGFACILITY NUMBER:
435700339
ADMINISTRATOR:FAN, SITINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 229-4527
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY:14CENSUS: 2DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Siting "Gracie" FanTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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1 - Day care children not supervised adequately
INVESTIGATION FINDINGS:
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On 07/28/2022 at 11:15am, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced visit for the purpose of investigating a complaint for the above allegation of lack of supervision and met with Licensee, Siting “Gracie” Fan. At the time of the visit there are 2 children present and 1 fingerprint cleared assistant.

Based on LPA’s documentation and interviews which were conducted and recorded, the preponderance of evidence standard has been met, therefore the above allegation of day care children not supervised adequately is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division12, Chapter 1, Section 102417(a), is being cited as a Type A Violation on the attached LIC 9099D form. Additionally, an immediate civil penalty of $500.00 is being assessed today due to this violation on the attached LIC 421IM
form.

Page 1 of 2 ***Continued on LIC 9099C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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 4
Control Number 52-CC-20220719121932
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FAN, SITING
FACILITY NUMBER: 435700339
VISIT DATE: 07/28/2022
NARRATIVE
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LPA Uribe informed licensee, Siting “Gracie” Fan, that this report dated 07/28/2022 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, LPA Uribe informed the licensee to provide a copy of this licensing report dated 07/28/2022 that documents any 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.

A notice of site visit was given and must remain posted for 30 days. Copy of appeal rights and report was given. Exit interview was conducted with licensee, Siting “Gracie” Fan.


















Page 2 of 2 ***End of Report***
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 52-CC-20220719121932
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: FAN, SITING
FACILITY NUMBER: 435700339
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2022
Section Cited
CCR
102417(a)
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Title 22, Division 12, Chapter 1, Section 102417(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

This regulation is not met as evidenced by:
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Licensee will watch the Supervising Children in Family Child Care training video on the CCLD website (link below) and will create a written statement acknowledging her supervision responsibilities and create a list of ways that she will change her daily routine in order to ensure that all children present are being supervised at all times.
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The licensee did not ensure the proper supervision to children which poses an immediate health, safety, or personal rights risk to children in care.
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This written statement will be emailed to LPA Uribe at [email protected] by 1:00pm tomorrow, 07/29/2022.

https://ccld.childcarevideos.org/family-child-care-providers/supervising-children-in-family-child-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: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4