213005161-9-15-2021-05-CC-GLEG-C76VZB-20210924165228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 213005161
Report Date: 09/15/2021
Date Signed: 09/15/2021 04:03:03 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
07/01/2021 and conducted by Evaluator Farhan Bashir-Tariq

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210701143142

FACILITY NAME:	UNIVERSITY OF PLAY		FACILITY NUMBER:	213005161
ADMINISTRATOR:	BALLENGER, SYLVIA		FACILITY TYPE:	850
ADDRESS:	1055 LAS OVEJAS AVE RM#4		TELEPHONE:	(415) 499-0309
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	30	CENSUS: 12	DATE:	09/15/2021
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Sylvia Balleneger		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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There is no qualified staff available.
Children were left alone playing with unqualified teenage staff.

INVESTIGATION FINDINGS:

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On 9/15/21 at 2:00 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 12 children present today with two teachers and two aids. Facility was working in compliance to staff and children ratio on this day. On 7/09/21, LPA made an initial inspection of facility to start the investigation of this complaint. A subsequent on-site inspection was conducted today to deliver the findings. During the course of investigation, interviews were conducted with Director, Staff and Parents. As part of this investigation, copies of facility rosters were collected from Director via email.

This agency has investigated the complaint alleging that there is no qualified staff present and children were left alone with unqualified teenage staff. 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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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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