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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421543
Report Date: 01/04/2022
Date Signed: 01/04/2022 10:18:10 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, 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
09/23/2021 and conducted by Evaluator Briana Plumboy
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210923113040
FACILITY NAME:WU, ZI JUANFACILITY NUMBER:
013421543
ADMINISTRATOR:WU, ZI JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 706-8378
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:14CENSUS: 5DATE:
01/04/2022
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Zi Juan Wu- LicenseeTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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9
Personal Rights- Children are restrained
Lack of Care- Daycare children left out in the garage
Criminal Record Clearance- Adults in home are not cleared
INVESTIGATION FINDINGS:
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On 1/4/21 at 8:52am, Licensing Program Analyst (LPA) B. Plumboy met with licensee Zi Juan Wu for the purpose of an unannounced complaint inspection. Present for this inspection was 5 children in care and 1 adult whom is not fingerprint cleared or associated to the facility. Investigator B. Williams and LPA B. Plumboy both investigated the allegations filed. The allegations that the licensee has restrained children, left daycare children in the garage, and has had adults in her home whom are not cleared and associated to her facility has been SUBSTANTIATED. Based on LPAs observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. Title 22, Division 12, Chapter 1, Section 102423(a)(2) & 102370(d)(1) are being cited on the attached LIC. 9099D. LIC 9224 was issued and discussed. A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and discussed. An exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
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
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
09/23/2021 and conducted by Evaluator Briana Plumboy
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210923113040

FACILITY NAME:WU, ZI JUANFACILITY NUMBER:
013421543
ADMINISTRATOR:WU, ZI JUANFACILITY TYPE:
810
ADDRESS:40223 DAVIS STTELEPHONE:
(510) 706-8378
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:14CENSUS: 5DATE:
01/04/2022
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Zi Juan Wu- LicenseeTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Physical Abuse- Daycare child has suspicious injuries.
Personal Rights- Daycare children are not fed.
INVESTIGATION FINDINGS:
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On 1/4/21 at 8:52am, Licensing Program Analyst (LPA) B. Plumboy met with licensee Zi Juan Wu for the purpose of an unannounced complaint inspection. Present for this inspection was 5 children in care and 1 adult whom is not fingerprint cleared or associated to the facility.
Investigator B. Williams and LPA B. Plumboy both investigated the allegations filed. The allegations daycare children are not being fed and a daycare child had suspicious injuries is unsubstantiated. 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.
A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 52-CC-20210923113040
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WU, ZI JUAN
FACILITY NUMBER: 013421543
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2022
Section Cited
CCR
102423(a)(2)
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To receive safe, healthful, and comfortable accommodations, furnishings, and equipment
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On 9/30/21, licensee submitted a summary from the Personal Rights video on https://ccld.childcarevideos.org, on 11/1/21 the licensee attended an NCC meeting with CCLD, and on 11/30/21 the licensee and 2 assistants attended a training at Hively.
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This requirement was not met as evidence based on observations, record review, and interview with licensee. Daycare children were restrained and left in the garage which poses an immediate health and safety risk to children in care.
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$250 is also being assessed due to repeat violation. Further administrative action may be pending.
Type A
01/05/2022
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee will immediately forward a criminal record request to associate the male tenant to the facility. Licensee will ensure that prior to residing, each tenant's fingerprint clearance is associated with the facility.
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This requirement is not met as evidenced by observation and interview. There is a male residing in a room in the garage whom is not fingerprint cleared or associated which poses an immediate health and safety risk to children in care.
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TODAY AN IMMEDIATE CIVIL PENALTY OF $500 IS ASSESSED due to a tenant not having a clearance. $250 is also being assessed due to repeat violation. Failure to correct will result in a $100 per day civil penalty until corrected.
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: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3