<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005250
Report Date: 09/08/2021
Date Signed: 09/14/2021 02:02:46 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
08/24/2021 and conducted by Evaluator Haydee R Caliboso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210824110230
FACILITY NAME:ROBIN'S NEST PRE SCHOOL, INC. SAUSALITOFACILITY NUMBER:
214005250
ADMINISTRATOR:BENEDICT, ROCHELLEFACILITY TYPE:
850
ADDRESS:630 NEVADA STREETTELEPHONE:
(415) 331-5999
CITY:SAUSALITOSTATE: CAZIP CODE:
94965
CAPACITY:45CENSUS: 17DATE:
09/08/2021
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Rochelle BenedictTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/8/21 at 11:05am., Licensing Program Analyst (LPA) Haydee Caliboso arraived at the facility to conduct a closing complaint investigation in response to the above allegation. LPA spoke with the Director Rochelle Benedict. Present during the inspection were 17 children and 3Teachers.

Based on LPA's gathered information through observations and interviews with staff the agency has investigated the complaint allegation above. The facility failed to comply with a state or local COVID-19 public health order and CDSS COVID-19 guidelines. The preponderance of evidence standard has been met. The above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22,Division 12 & Chapter 1, are being cited on the attached LIC 9099D.


This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. Appeal Rights were provided to the facility. This report and rights to comment and appeal have been discussed.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 05-CC-20210824110230
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ROBIN'S NEST PRE SCHOOL, INC. SAUSALITO
FACILITY NUMBER: 214005250
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2021
Section Cited
CCR
101223(a)(2)
1
2
3
4
5
6
7
101223(a)(2)Personal Rights:
(a)The licensee shall ensure that each child is accorded the following personal rights:

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The staff will wear face mask when providing care to children regardless of staff's vaccination status. The facility will comply required by the CA Dept. of Public Health guidance and CDSS guidance on the use of face coverings. All staff shall review and be aware of the health guidance up through 7/28/21. Facility will submit a list of staff and date of Health Guidance review by due date of 9/21/21.
8
9
10
11
12
13
14
Based on observation and interview with staff on 8/26/21, the staff of the facility did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that facility S1 and S2 did not wear face coverings while in the facility, as required by the CA Dept. of Public Health Guidance on the Use of Face Coverings issued on 6/18/20 and updated 7/28/21, and an individual mask exception did not apply. This poses a potential risk to children in care.
8
9
10
11
12
13
14
09/03/2021
Section Cited
CCR
101223(a)(2)
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: Cindy InterianoTELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2