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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313681
Report Date: 11/02/2021
Date Signed: 11/02/2021 12:59:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/05/2021 and conducted by Evaluator Cindy Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20211005132429
FACILITY NAME:LI, JIARONGFACILITY NUMBER:
304313681
ADMINISTRATOR:LI, JIARONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(718) 517-0885
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:14CENSUS: 4DATE:
11/02/2021
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee, Jiarong LiTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Child sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nguyen conducted an unannounced investigate the above allegation. This is a continuation of the investigation initiated on 10/12/21. LPA meet with licensee, Li, Jiarong and explained the reason for the inspection. At 12:15 pm the licensee guided LPA on a tour of the facility. Present at the time of the inspection was the licensee, licensee’s assistant, and 4 day care children, 3 of which were under the age of two year. During today's inspection staffing ratios were being met and the facility was operating within its licensed capacity. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 10/05/2021 a complaint was filed with the Department alleging that Child #3 (C3), while in care during March 2020, prior to COVID-19, received 3 injury marks on the left ear and on the head. Complainant stated that it looked like child hit his head on something. Complainant stated there was no blood, but the scratches were visible. Continued on Page 2

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
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 2
Control Number 06-CC-20211005132429
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LI, JIARONG
FACILITY NUMBER: 304313681
VISIT DATE: 11/02/2021
NARRATIVE
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Page 9099C

During the investigation, LPA conducted 2 physical plant inspections, interviewed two staff members, two children, a parent, and reviewed facility roster. All staff interviewed denied ever knowing or observing C3’s scratches at the facility. Staff #1 (S1) stated child was sick for a few days, so when the child came back to the facility, child was little fussy and have a hard time napping. The child moved around a lot inside the crib when taking nap on that day. When C3 left the facility, S1 stated they didn’t recall observing any marks for scratches on the child. S1 stated they couldn’t recall anything abnormal happen on that day beside Child #3 (C3) being little fussy and that C3 scratched S1 when trying to comfort C3. S1 reported they are always with the children, even during nap time. S1 couldn’t recall anything happen to C3 at the facility. Staff #2 (S2) stated the scratches couldn’t have happen at the facility because we are always with the children. S2 was not aware of any incident occurring while C3 was in care that would have made the red marks. S1 cares for only five children, including two of her own. The children interviewed were either too young to qualify or did not disclosed any information to support the allegation. S1 currently has three families enrolled. LPA contacted all three parents by phone and was able to talk to a one parent. Parent interviewed did not express any concerns with the care and supervision given to the children, or have any concerns with any staff at the facility. Parent stated they would recommend facility to others.

Based on LPA observations, document reviews and interviews which were conducted, the preponderance of evidence was not met, therefore the above allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with licensee, Li, Jiarong. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2