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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420448
Report Date: 03/21/2024
Date Signed: 03/21/2024 03:08:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2024 and conducted by Evaluator Brittany Crass
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240313112426
FACILITY NAME:HE, ZHIFACILITY NUMBER:
013420448
ADMINISTRATOR:HE, ZHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 290-3827
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 8DATE:
03/21/2024
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Zhi HeTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Uncleared adult(s) living in the day care home.
INVESTIGATION FINDINGS:
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On 3/21/2024 at 1:35PM Licensing Program Analysts (LPA) B.Crass and A.Curry arrived at the facility for an unannounced subsequent complaint visit. LPAs met with the licensees' fingerprint cleared assistant and fingerprint cleared son, to explain the purpose of todays visit. The licensee, Zhi He, arrived at the facility during the visit. LPAs previously toured the entire home, reviewed documentation, and conducted interviews with staff and children. The licensee indicated her nephew, Cheng Heng, moved into the home on March 1st, 2024 and he is not fingerprint cleared. The licensee also stated, prior to the nephew living in the home, a UC Berkeley student lived in the home briefly, who was also not fingerprint cleared. Based on observation and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Section 102370(d)(1) is being cited on 9099-D page. The licensee was advised that she needs to close her facility, or the nephew is not allowed to return until he has an eligible clearance. Please check Guardian, or contact the Oakland office, to verify the status of his clearance.
(Report continued, see 9099-C).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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 02-CC-20240313112426
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HE, ZHI
FACILITY NUMBER: 013420448
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/22/2024
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance
(d) All individuals subject to a criminal record review... shall prior to working, residing, or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required...
This requirement is not met as evidence by:
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By 3/22/24, the licensee needs to either close her facility, or the nephew has to leave and is not allowed to return to the facility until he has an eligible criminal record clearance. The licensee will email LPA her plan to comply with the regulation.
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Based on observations, record review, and interviews, the licensee did not comply with the section cited above by allowing her uncleared nephew, Cheng Heng, to live in the home without an eligible criminal record clearance.
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Please check Guardian, or contact the Oakland office to verify the status of his clearance.
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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: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20240313112426
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HE, ZHI
FACILITY NUMBER: 013420448
VISIT DATE: 03/21/2024
NARRATIVE
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LPA B. Crass informed licensee Zhi He that this report, dated 3/21/2024, documents 1 type A citation, which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights, to children in care.

Also LPA B.Crass, informed licensee Zhi He to provide a copy of this licensing report dated 3/21/2024 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. Assigned Acknowledgment of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the childs file for verification.

Exit interview conducted, appeal rights were given, notice of site visit was given, and report was reviewed with the licensee Zhi He.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3