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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 213001939
Report Date: 08/04/2021
Date Signed: 08/24/2021 02:24:28 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
05/26/2021 and conducted by Evaluator Haydee R Caliboso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210526101307
FACILITY NAME:C.A.M (CFS) HAMILTON (PS)FACILITY NUMBER:
213001939
ADMINISTRATOR:AMANDA TATUMFACILITY TYPE:
850
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-3791
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:60CENSUS: 8DATE:
08/04/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Michelle HernandezTIME COMPLETED:
01:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Right: Staff person hit daycare children.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/4/21 12:50PM., Licensing Program Analyst (LPA) Haydee Caliboso conducted a closing complaint investigation in response to the above allegation. LPA spoke with Michelle Hernandez. Present during the inspection were 42 children and 11Teachers.

Based on LPA's gathered information through interviews with staff, guardian, and pediatrician and record review the agency has investigated the complaint allegations above. Although, the allegation of staff person hit daycare children may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch.1
An exit interview was conducted. Appeal rights were given and explained to Licensee and a copy was provided. A Notice of Site Visit was posted during this inspection.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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