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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018983
Report Date: 04/20/2021
Date Signed: 04/20/2021 11:18:22 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
03/30/2021 and conducted by Evaluator Nolan Tcheng
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20210330105918
FACILITY NAME:BAO FAMILY CHILD CAREFACILITY NUMBER:
198018983
ADMINISTRATOR:XUEFEI BAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 456-1322
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:14CENSUS: 8DATE:
04/20/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Xuefei Bao - LicenseeTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child sustained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An unannounced in person inspection was conducted by Licensing Program Analyst (LPA) Nolan Tcheng for the purpose of delivering complaint findings. Upon arrival at 9:30am, LPA was greeted by Hong Xie, Assistant, and let into the facility. LPA then met with Licensee Xuefei Bao to whom the purpose of the inspection was announced.

At 9:35am, Staff #1 provided a tour of the facility and census was taken. There were eight children present during the time of inspection. Staff Child Ratio was met.

During the course of the investigation interviews were conducted with two staff, two adults, two children and the reporting party. Documentation was obtained in the form of Child Care Facility Roster, photos, videos, police reports, and screenshots of a text message conversation.

REPORT CONTINUES PAGE 1 of 3
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
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-20210330105918
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: BAO FAMILY CHILD CARE
FACILITY NUMBER: 198018983
VISIT DATE: 04/20/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Pertaining to the allegation that “Child sustained injuries while in care:” this allegation refers to an incident which occurred 03/29/2021. Staff #1 and Adult #1 (A1) both stated that A1 was notified of the injuries during the time of pick up. Staff #1 disclosed, Child #9 (C9) sustained injury while in care at the facility. During morning meal time, C9 fell forward in their chair, landing on their face, sustaining an injury. Photographs show Child #9 with a cut on the inside of their upper lip and discoloration below bottom lip. According to Child #1 (C1), C1 observed C9 falling while in the outside play area and hitting the back of their head on the surrounding play area fence. Per interviews with Staff #1 and Staff #2, they did not observe Child #9 injuring the back of their head while in the outside play area. Documentation in the form of photos shows dried scabs on the back of C9’s head as well as dried blood on the back button clasp of C9’s bib.

This agency has investigated the complaint alleging that there was a violation of Title 22, Division 12, Chapter 1, Article 6, Section 102417 "Operation of Family Child Care Home.” The complaint alleged that “Child sustained injuries while in care.” Based upon the evidence as presented above, the allegation has been determined to be Substantiated. A finding of Substantiated means that the preponderance of evidence standard has been met. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 102417 "Operation of Family Child Care Home" is being cited on the attached LIC 9099D.

Please refer to 9099D for documentation of deficiencies.

Upon receipt, the Licensee shall post the “D” page of the Licensing report. This page shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.



Notice of Site Visit was given to Licensee. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 Civil Penalty.

REPORT CONTINUES PAGE 2 of 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20210330105918
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: BAO FAMILY CHILD CARE
FACILITY NUMBER: 198018983
VISIT DATE: 04/20/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
An exit interview was conducted with Licensee Xuefei Bao, at 11:20am. A copy of this report was signed and appeal rights were provided to licensee.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20210330105918
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: BAO FAMILY CHILD CARE
FACILITY NUMBER: 198018983
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/21/2021
Section Cited
CCR
102417(a)
1
2
3
4
5
6
7
102417(a) Operation of Family Child Care Home
The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Per licensee, licensee and Staff #2 will watch the video regarding Supervising Children at ccld.childcarevideos.org and write a small summary about the video. Licensee will submit the summary to LPA by POC date 04/21/2021.
8
9
10
11
12
13
14
Staff #1 did not ensure supervision at all times. Based on interviews, Staff #1 and Staff #2 did not observe Child #9 injuring the back of their head at facility. This poses an immediate risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4