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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013417235
Report Date: 05/24/2022
Date Signed: 05/24/2022 09:39:58 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, 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
05/17/2022 and conducted by Evaluator Sidney Cortez
COMPLAINT CONTROL NUMBER: 52-CC-20220517115535
FACILITY NAME:FUSD - BLACOW STATE PRESCHOOLFACILITY NUMBER:
013417235
ADMINISTRATOR:GLIDEWELL, MARIAFACILITY TYPE:
850
ADDRESS:40404 SUNDALE DRIVETELEPHONE:
(510) 353-9728
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:24CENSUS: DATE:
05/24/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Glidwell, Patrica Angel and Jose HernandezTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Day care child sustained injuries while in care --(3) Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cortez met with the staff of Blacow State Preschool for a complaint investigation regarding the above allegation.

Present during the inspection was ( 0 ) pre school age children since it was a Parent Teacher Conference Day, and the 2 teachers

Based on the interviews conducted and observation, the allegation that a daycare child was injured while in care is UNSUBSTANTIATED. 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.

A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were given and discussed. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
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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