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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015701016
Report Date: 10/09/2024
Date Signed: 10/09/2024 01:44:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
09/12/2024 and conducted by Evaluator Jyoti Saini
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240912085848
FACILITY NAME:LIEN, SHUANGFACILITY NUMBER:
015701016
ADMINISTRATOR:LIEN, SHUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 386-1921
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:14CENSUS: 0DATE:
10/09/2024
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Licensee, Shuang Lien.TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Licensee did not ensure day care child had eaten.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Jyoti Saini and Briana Plumboy arrived unannounced to deliver the findings from a complaint investigation for the above allegation and met the licensee, Shuang Lien.The findings were delivered at 4776 Fawn Way, dublin instead of 4786 Fawn Way, Dublin since the provider has moved to a new location and no longer has access to the old location.
Based on the interview, record review, and observations, the facility indicated that the food was offered to the child, but the child refused to eat it. Interviews with clients involved did not reveal any concerns. Therefore, the alleged Licensee did not ensure day care child had eaten may have happened or is valid; there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated.
An exit interview was conducted with Licensee, Shuang Lien. Appeal rights were given.
A notice of site visit was posted and must remain posted for a period of 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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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