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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414001763
Report Date: 11/02/2021
Date Signed: 11/02/2021 11:50:31 AM

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
09/16/2021 and conducted by Evaluator Catrina Quimbo
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210916132935
FACILITY NAME:KUNG, SHERRY LIUFACILITY NUMBER:
414001763
ADMINISTRATOR:KUNG, SHERRY LIUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 570-6966
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:14CENSUS: 6DATE:
11/02/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Sherry KungTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Care provider inappropriately disciplined day care child.
INVESTIGATION FINDINGS:
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On November 2, 2021 at 11:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, complaint visit to Sherry Kung Family Child Care Home regarding above allegation. LPA met with Licensee, Sherry Kung. The purpose of the visit was explained to licensee.

Present in the home was Licensee and 6 enrolled children (3 infants and 3 preschool age). As part of this complaint investigation, LPA conducted facility observations, interview with Licensee and random selection of children’s parents, and reviewed records and documents.

During facility observations, LPA did not observe providers to be mishandling or inappropriately disciplining children in care. Random selection of parents interviewed stated they have never observed providers to be mishandling or inappropriately discipling children in care at facility. LPA obtained record that provides additional statement from additional random parent stating they have never observed providers mishandling or inappropriately discipling children in care at facility.

(Continue on Page 2...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
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 05-CC-20210916132935
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: KUNG, SHERRY LIU
FACILITY NUMBER: 414001763
VISIT DATE: 11/02/2021
NARRATIVE
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(Continued, Page 2...)

Although the above allegation may have happened or is valid, based on LPA’s observations, interviews and record review which were conducted, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

After today’s visit, an exit interview was conducted with Licensee, Sherry Kung. LPA and Licensee discussed capacity limits and requirements when working without a helper. Upon receipt of this report, Licensee shall post the Notice of Site Visit. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
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