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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198006989
Report Date: 07/06/2022
Date Signed: 07/06/2022 11:42:26 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
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 Jennifer Hua
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220628104050
FACILITY NAME:GUAN FAMILY CHILD CAREFACILITY NUMBER:
198006989
ADMINISTRATOR:GUAN, PINGNA AND HUAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 569-9032
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:14CENSUS: 5DATE:
07/06/2022
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Pingna Guan & Hua GuanTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Child sustained unexplained injuries while in care
Licensee did not provide the child's authorized representative with incident
INVESTIGATION FINDINGS:
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Complaint investigation conducted by Licensing Program Analyst Jennifer Hua. LPA met with licensees Pingna Guan & Hua Guan. LPA informed licensees, the purpose of the visit. Licensee Pingna Guan took LPA on the tour of the facility. LPA observed no children in care at the time, per licensee Pingna children won't be here until around 10am today. LPA reviewed allegations with licensees. During this visit, 5 children arrived.

Interviews conducted with licensees. Licensee Pingna stated that she was not aware that child sustained injury on finger until maternal grandma brought it her attention the next day. Licensee Hua stated he did not notice cut on child's hand. Licensees both confirmed that they noticed 2 small bumps on back of child's head last Wednesday at around 11am, which were not there at drop off at 9am. The licensee's confirmed that the child sustained the bumps at the faciltiy, but not sure how the bumps came about. Licensees believe they might of been mosquito bites because there were no incidents with the child. Licensees stated that they are not aware of any injury on child's back. Parent never mentioned it and they did not remove child's clothes to check.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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 33-CC-20220628104050
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GUAN FAMILY CHILD CARE
FACILITY NUMBER: 198006989
VISIT DATE: 07/06/2022
NARRATIVE
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Licensees confirmed that they did not report the injury/bumps to parent. Licensee stated that she forgot to inform parent at pick up..

This agency has investigated the complaint alleging child sustained unexplained injuries while in care and Licensee did not provide the child's authorized representative with incident report. Based on LPA's interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22 are being cited on the attached LIC 9099Ds.

Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.

Exit interview was conducted with Pinga Guan, licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20220628104050
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GUAN FAMILY CHILD CARE
FACILITY NUMBER: 198006989
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2022
Section Cited
CCR
102423(a)(2)
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Personal Rights.Each child receiving services from a Family Chld Care Home, to receive safe, healthful, and comfortable accommodations, furnishings, and equipment..
The requirement is not met as evidenced by: Licensees were not aware how child sustained cut on finger and 2 small bumps on back of child's head. Thisl poses an immediate health and safety of children in care.
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 Per licensee, will supervise children more closely to ensure compliance.
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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: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20220628104050
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GUAN FAMILY CHILD CARE
FACILITY NUMBER: 198006989
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2022
Section Cited
CCR
102416.2(f)
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Reporting Requirements. As soon as possible but no later then the same business day, the licensee shall notify a child's parent or authorized representative regardless of the injuries or acts that affect that child as specified in Health and Safety Code Section 1597.467(a). The requirement is not met as evidenced by: Licensee stated the injury was not reported to parent. This poses a potential health and safety hazard to children in care..
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Per licensee, willl notify parent immediately upon any incident or injury that affect the child to ensure compliance. Licensee stated will call or text parent immediately and send photo if necessary.
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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: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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