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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 213001117
Report Date: 11/22/2021
Date Signed: 11/22/2021 03:10:39 PM



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
10/08/2021 and conducted by Evaluator Farhan Bashir-Tariq
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211008093524
FACILITY NAME:JCC PRESCHOOL SAN RAFAELFACILITY NUMBER:
213001117
ADMINISTRATOR:RACHEL FALKFACILITY TYPE:
850
ADDRESS:200 N. SAN PEDRO ROADTELEPHONE:
(415) 444-8044
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:150CENSUS: 47DATE:
11/22/2021
UNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Tamar LaiTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff isolate daycare child.
Staff are discriminating against child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/22/21 at 2:40 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to deliver the findings of this complaint investigation. Purpose of inspection was explained. There were 47 children present today. Facility was working in compliance to staff and children ratio on this day. LPA made an initial visit to the facility on 10/14/21, a subsequent visit on 11/16/21 and a final visit today to deliver the findings of this complaint. During the course of investigation, LPA conducted interviews with Directors, staff and parents. As part of this investigation, copies of the following documents were received from Directors via emails: facility roster, personnel report, parent’s handbook, and email communications.

This agency has investigated the complaint alleging the allegations above. Based on the information obtained, 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 UNSUBSTANTIATED. No citations were issued on this report. This report must be available in the facility for public review. Facility was advised to call office for any additional questions, M - F, 8 AM-5 PM at 650-266-8800. Website: www.cdss.ca.gov

End of Report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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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