214005105-2-7-2024-05-CC-GLEG-D2A42T-20240208174340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 214005105
Report Date: 01/04/2024
Date Signed: 02/07/2024 12:28:13 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
12/05/2023 and conducted by Evaluator Hanson Leong

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20231205163225

FACILITY NAME:	FIGUEROA, ESLY		FACILITY NUMBER:	214005105
ADMINISTRATOR:	FIGUEROA, ESLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 256-9101
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	14	CENSUS: 9	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Esly Figueroa		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Facility is over capacity

INVESTIGATION FINDINGS:

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***This is an amended complaint report from 1/4/2024. ***.

On 1/4/2024, Licensing Program Analysts (LPAs) Leong and Gil made an unannounced complaint visit to the Family Child Care Home listed above. The purpose of the visit was to deliver the findings and to close out the complaint. The LPAs were granted entry by the Licensee, Esly Figueroa. Ms. Figueroa was informed of the reason for today's visit by the LPAs. Present in the home included Ms. Figueroa, Ms. Figueroa’s assistant, three preschool-aged children, two infants, and four school-aged children. All individuals listed on the facility’s roster have been granted permission to work or be present in a Family Child Care Home. The home operates within its capacity and in accordance with the required ratio of staff to children.

All relevant information was gathered and analyzed during the LPA investigation, and all parties involved were contacted and interviewed. Based on the information obtained during the investigation and record review, LPA found that the licensee cared for 15 children for at least one day in October 2023, exceeding the license’s capacity. Therefore, the preponderance of evidence has been met, and the above allegation is found to be substantiated.
See Page 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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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Control Number 05-CC-20231205163225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FIGUEROA, ESLY	FACILITY NUMBER: 214005105
	VISIT DATE: 01/04/2024

NARRATIVE

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Continued, Page 2
The LPAs informed Ms. Figueroa to provide a copy of this licensing report dated 1/4/2024 that documents any Type A citations to the parents or guardians of all children currently enrolled by the next business day or the next day the children are in care and to the parents or guardians of any newly enrolled children for 12 months from the date of this report. The deadline for providing this information is the next business day, 1/5/2024. For verification purposes, the department will require the child's file to have a signed Acknowledgment of Receipt of the Licensing Report (LIC 9224), or another form of written statement.

Please reference LIC 9099D for today's Type A citation.

A copy of today’s report and the facility's appeal rights were given to Esly Figueroa. A Notice of Site Visit and the LIC 9099D were given to Esly Figueroa and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Esly Figueroa

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

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Control Number 05-CC-20231205163225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FIGUEROA, ESLY	FACILITY NUMBER: 214005105
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/04/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/05/2024 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee must comply with the maximum number of children allowed for the facility's license. An updated children's roster (LIC 9040), and children's schedule must be submitted to the department.
	8 9 10 11 12 13 14	Based on observation, interview, and record review, the licensee did not comply with the section cited above in October 2023, which poses an immediate health, safety, or personal rights risk to children in care. *This is an amended complaint report from 1/4/2024. *.	8 9 10 11 12 13 14	Authorized Representatives must sign the LIC9224, Notice of A type deficiency. A follow-up visit will be required to ensure that the license is in accordance with the section cited above.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

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