434415351-8-20-2025-07-CC-GKUN-DKZUTQ-20250829155216

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415351
Report Date: 08/20/2025
Date Signed: 08/20/2025 04:51:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/18/2025 and conducted by Evaluator Linke Huang

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20250618104518

FACILITY NAME:	GONG, YI		FACILITY NUMBER:	434415351
ADMINISTRATOR:	GONG, YI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(469) 307-4368
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95120
CAPACITY:	14	CENSUS: 9	DATE:	08/20/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Gong, Yi		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Neglect/Lack of Supervision resulting in child sustaining an unexplained fracture
Licensee is not present in the home a sufficient amount of time during day care hours

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kate Huang conducted an unannounced complaint visit to deliver investigation findings regarding the above allegations. LPA met with licensee, Yi Gong, and explained the purpose of the visit.

During the visit, LPA observed that there were 4 infants and 5 preschoolers with licensee and two assistants present.

It was alleged that, due to lack of supervision, a child (C1) sustained an unexplained fracture.

On 06/25/2025, Community Care Licensing Division’s Investigations Bureau investigators (IB) and LPA Kate Huang conducted an unannounced visit at the facility, inspected the play structure where the incident occurred, obtained copies of facility documents, and interviewed licensee, two staff members and three children.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025

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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Control Number 07-CC-20250618104518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONG, YI	FACILITY NUMBER: 434415351
	VISIT DATE: 08/20/2025

NARRATIVE

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During the investigation, IB interviewed the reporting party (RP), the victim’s parents, child (C1), and other daycare parents. IB also reviewed all documents received, including medical records, the children’s roster, children’s files, and incident reports.

The investigation revealed that C1 sustained fracture while in care. However, there is insufficient evidence to conclude that the fracture resulted from staff's lack of supervision. Based on interviews, C1 fell while playing in the play structure. C1 stated staff came to assist. It was unclear whether staff was present in the area or came from the inside to assist C1. 2 children who were interviewed stated there was staff present in the outdoor play area when C1 fell. Staff stated they were present in the play area when the fall occurred, but had conflicting statements on where they were positioned in the play area when C1 fell.

It was also alleged that licensee is not present in the home a sufficient amount of time during day care hours.

LPA Huang conducted a subsequent unannounced inspection on 07/22/2025, observed the licensee's attendance, and interviewed the licensee and one staff member. Both stated that the licensee is present at the daycare every day and remains for almost the entire duration of operating hours, except for occasional short absences. In addition, parents who were interviewed by LPA stated that they do not believe the licensee has ever been absent from daycare for more than two hours during operating hours.

The Department has investigated the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies were cited. Exit interview was conducted, where the report was reviewed and discussed with licensee Gong, Yi in Mandarin. A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025

LIC9099 (FAS) - (06/04)

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