Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018431
Report Date: 12/15/2015
Date Signed 12/15/2015 04:59:02 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2015 and conducted by Evaluator Brandi VanOosten
COMPLAINT CONTROL NUMBER: 33-CC-20151210092849
FACILITY NAME:CAO & CHIANG FAMILY CHILD CAREFACILITY NUMBER:
198018431
ADMINISTRATOR:CAO,LING YAN & CHIANG,BOBFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 513-0168
CITY:ARCADIASTATE: ZIP CODE:
91007
CAPACITY:14CENSUS: 6DATE:
12/15/2015
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Ja-Hye PangTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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OTHER:
- Two adults present with children do not have the required criminal record clearances on file.
- Licensee's are not present for the required 80 percent of the time at the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brandi Van Oosten conducted a complaint visit to gather information in regards to the above allegations. Upon LPA arrival, LPA met with Ja-Hye Pang and Peng Yun Wang. Both licensee's were not present during this visit. Ja-Hye Pang does have a criminal record clearance on file, however, has not been properly associated to this facility. Peng Yun Wang does not have a criminal record clearance on file.

Based on interviews conducted, it was also found that the primary caregivers of this facility during the morning and sometimes afternoon hours are are Ja-Hye Pang and Peng Yun Wang. Both licensees are currently working outside of the home.

Based on the LPAs observations and interviews conducted during this visit, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22 (regulation number), are being cited on the attached LIC 9099D.

REPORT CONTINUES ON THE NEXT PAGE 1 OF 2
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2015
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 4


Control Number 33-CC-20151210092849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2015
Section Cited
102417(a)
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Operation of a Family Child Care Home.
Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Based on the information provided during this visit, the licensee's are not present for the required 80 percent of the operating hours of the facility.
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Per Ling Yan Cao, Licensee, her spouse Bob Chiang will be present at the facility starting tomorrow and will be the primary caregiver at the facility.

The licensee will submit a plan in writing.
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Both licensee's are currently working outside of the home.

This 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.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2015
LIC9099 (FAS) - (06/04)
Page: 2 of 4



Control Number 33-CC-20151210092849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
VISIT DATE: 12/15/2015
NARRATIVE
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Ling Yan Cao, Licensee arrived to the facility at 10:30 AM. The conclusion of visit was done with Ms. Cao.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

Exit interview was conducted with Ling Yan Cao, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2015
LIC9099 (FAS) - (06/04)
Page: 3 of 4


Control Number 33-CC-20151210092849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/16/2015
Section Cited
102370(d)(1)
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Criminal Record Clearance. Prior to working in a licensed facility, all individuals subject to a criminal record review as specified in Section 1596.871 shall obtain a California clearance or a criminal record exemption as required by the Department.

Peng Yun Wang was present during this visit and does not have a criminal record clearance.
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Per licensee, Ms. Wang will complete Live Scan immediately. Proof that Live Scan has been completed will be submitted.
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Ms. Wang has been working at the facility for about six months.

This poses an immediate Health and Safety risk to children in care.

CIVIL PENALTIES ASSESSED
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Type A
12/16/2015
Section Cited
102370(d)(2)
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Criminal Record Clearance. Prior to working, in a licensed home, all personnel shall request a transfer of a criminal record clearance as specified in Section 102370 (j).

Ja-Hye Pang was present during this visit. Ms. Pang has been working at the facility since the facility opened, as she worked at Little Wonders
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Per licensee, the required transfer form will be submitted to the Department.

Criminal Background Clearance Transfer Request (LIC 9182) was completed during this visit and provided to the LPA.
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Academy Child Care Center. Ms. Pang does have a criminal record clearance on file, however, she has not been properly transferred to this facility.

This poses an immediate Health and Safety risk to children in care.

CIVIL PENALTIES ASSESSED
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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.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2015
LIC9099 (FAS) - (06/04)
Page: 4 of 4