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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004998
Report Date: 06/17/2024
Date Signed: 06/17/2024 04:09:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2024 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240410103721
FACILITY NAME:WANG, ZHONGLINFACILITY NUMBER:
414004998
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
06/17/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Zhonglin Wang and Michael ShenTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Licensee did not ensure the facility was free from pests.
Individuals not associated to facility are present in home.
INVESTIGATION FINDINGS:
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On June 17th, 2024 Licensing Program Analyst (LPA) Kassandra Medrano, conducted a subsequent site visit to the facility to deliver investigation findings. LPA met with Zhonglin Wang, Licensee, and Michael Shen, Facility Representative the purpose of the visit was explained. Michael was present and translated for Zhonglin as licensee speaks only Mandarin.

During the course of the investigation, LPA Medrano interviewed staff, facility representatives, and parents. Based on interviews, observations, as well as information gathered; it was found that an individual was present in the home that was not associated. The facility was cited on 4/12/2024 and civil penalties were assessed. As well as it was found that rodents and droppings were found in the presence of children. During inspections to facility no rodents or droppings were found. Per licensee the issue has been resolved. The allegations noted above are thus found to be SUBSTANTIATED, meaning the allegations are valid and the preponderance of the evidence standard has been met.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
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 2
Control Number 05-CC-20240410103721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WANG, ZHONGLIN
FACILITY NUMBER: 414004998
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2024
Section Cited
CCR
102417(b)
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Operation of family child care home
(b)The home shall be kept clean and orderly...
This requirement was not met as evidenced by:
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Licensee to send proof of rodent prevention and ensure facility stay free of droppings. Document to be sent via email.
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Based on interviews and documents recieved it was found that there were rodent and rodent droppings found in the facility. This poses a potential health and saety risk to children in care.
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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: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC9099 (FAS) - (06/04)
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