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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 213005156
Report Date: 11/22/2021
Date Signed: 11/22/2021 02:25:52 PM

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
10/08/2021 and conducted by Evaluator Farhan Bashir-Tariq
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211008140847
FACILITY NAME:NOVATO ENRICHMENT CARE-MISS NICKY'S PRESCHOOLFACILITY NUMBER:
213005156
ADMINISTRATOR:FLETCHER, NICOLEFACILITY TYPE:
850
ADDRESS:360 NOVA ALBION WAYTELEPHONE:
(415) 479-8980
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:60CENSUS: 0DATE:
11/22/2021
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Nicole FletcherTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not have access to daycare child's emergency medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/22/21 at 1:35 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 no children present today. LPA made an initial visit to the facility on 10/14/21 and a subsequent visit today to deliver the findings. During the course of investigation, interviews were conducted with Director, Staff and Reporting Party. LPA reviewed child’s file. As part of this investigation, copies of the following documents were received from Director via email: facility roster, email communications, personnel report, consent for emergency treatment form, and list of authorized representatives to pick up child.

This agency has investigated the complaint alleging that staff did not have access to day care child’s emergency medication. 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:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
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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