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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421124
Report Date: 08/10/2022
Date Signed: 08/10/2022 04:13:51 PM

Unsubstantiated


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
06/28/2022 and conducted by Evaluator Kelly Phan
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220628110637
FACILITY NAME:PHAN, HANGFACILITY NUMBER:
013421124
ADMINISTRATOR:PHAN, HANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 305-7483
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY:14CENSUS: 11DATE:
08/10/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Hang PhanTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility had an outbreak of food poisoning.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/10/2022 approximately at 1:05PM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced complaint visit to deliver the findings, and met with Licensee Hang Phan. Present for this inspection was licensee, licensee's fingerprinted and associated parents along with two staff members, and 9 preschool aged children and 2 infants.

During the course of the investigation, interviews and observations were conducted. It was alleged that the facility had an outbreak of food poisoning. During interviews and tours of the facility, it could not be determined if the incidents were caused by food poisoning. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. Exit interview conducted. Appeal rights and notice of site visit was given to licensee Phan.


Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
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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