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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004302
Report Date: 08/19/2021
Date Signed: 11/04/2021 04:48:05 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, 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
06/23/2021 and conducted by Evaluator Marie Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210623081020
FACILITY NAME:CHEN, HELENFACILITY NUMBER:
384004302
ADMINISTRATOR:CHEN, HELENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 385-9552
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:14CENSUS: 10DATE:
08/19/2021
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Helen ChenTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Licensee is allowing children to use an off-limits area
INVESTIGATION FINDINGS:
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*************** THIS IS AN AMENDED REPORT FROM ORIGINAL DATED 9/21/2021 *********************

Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced inspection to deliver finding and close complaint. LPA met with Licensee Helen Chen and explained purpose of visit. Present in home at time of visit was the Licensee, two helpers, and 10 children in care (preschool age).

During the course of the investigation, physical plant tour and interviews were conducted and relevant documents were reviewed. It was found based on the information provided the Licensee was using an off-limit area, the patio area of apartment, but did not notify CCLD office of the change of off-limit area to be used as a day care area. Based on additional information received from Licensee, it was determined that the patio area is not part of the licensed facility per Licensee’s lease agreement.

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 closed as UNSUBSTANTIATED.

This amended report is to be mailed to Licensee for signature.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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 3
Control Number 05-CC-20210623081020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CHEN, HELEN
FACILITY NUMBER: 384004302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
08/19/2021
Section Cited
CCR
102416.3(a)(6)
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Alterations to Existing Buildings or Grounds (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement has not been met as evidenced by:
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Plan of Correction (POC) was corrected during the annual inspection conducted on June 29, 2021. LPA inspected patio for health and safety hazards and discussed supervision of children while using the open patio area with Licensee.
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Based on observations and interviews, Licensee failed to notify CCLD of a change in an off limit area to a day care area of home. Licensee was using the patio, listed as an off-limit area in facility sketch, as part of the day care which poses a potential health and safety 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: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 05-CC-20210623081020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHEN, HELEN
FACILITY NUMBER: 384004302
VISIT DATE: 08/19/2021
NARRATIVE
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SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3