<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422269
Report Date: 09/20/2022
Date Signed: 09/20/2022 12:04:21 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
04/12/2022 and conducted by Evaluator Kelly Phan
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220412153956
FACILITY NAME:LI, WEI MINGFACILITY NUMBER:
013422269
ADMINISTRATOR:LI, WEI MINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 407-2878
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:14CENSUS: 0DATE:
09/20/2022
ANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Wei Ming TIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Questionable Death
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On September 20, 2022 at 11:05AM, Licensing Program Analyst (LPA) Kelly Phan met with licensee Li to deliver findings for the allegation stated above at a local Starbucks (5034 Mowry Ave, Fremont CA 94538). Present for the visit was just the licensee. Per licensee's request, she wants to meet at a local Starbucks to discuss findings due to the traumatic event at her facility.

During the course of the investigation, the complaint investigation was handled by the Investigation Branch (IB) investigator, Maria Barragan along with two other LPA Williams and Saini at the time. It is alleged there was a questionable death of a day care child. 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 was conducted. Appeal rights and notice of site visit was given and must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00

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

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
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 3