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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005278
Report Date: 10/26/2021
Date Signed: 10/27/2021 11:29:06 AM



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
10/21/2021 and conducted by Evaluator Haydee R Caliboso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211021143424
FACILITY NAME:MAJOULET, HEATHERFACILITY NUMBER:
214005278
ADMINISTRATOR:MAJOULET, HEATHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 225-5770
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:14CENSUS: 10DATE:
10/26/2021
UNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Heather MajouletTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Licensee is operating over capacity.
INVESTIGATION FINDINGS:
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On 10/26/21 at 3:16PM Licensing Program Analyst (LPA) Haydee Caliboso conducted a 10- day complaint inspection in response to above allegation. LPA met with the Licensee, Heather Majoulet and explained the purpose of the inspection. Present during the inspection was the Licensee, Assistant Teacher, 5 school-age children, and 5 preschool children.

During the investigation, interview with the Licensee, and documentations of children attending the program was obtained. In addition, LPA Haydee Caliboso obtained children's timecards and sign in and out sheets. Based on the documentation, it was observed that in month of September, Licensee had a total of 17 children enrolled including 1 infant during morning / daytime and in the evening time in Septemeber 2021. LPA explained the ratio to the licensee.

Based on LPA interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D. Copy of this report is reviewed and provided to the licensee.

Notice of site visit is posted and shall remain posted for next 30 days.

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: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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-20211021143424
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: MAJOULET, HEATHER
FACILITY NUMBER: 214005278
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/26/2021
Section Cited
CCR
102416.5(1)(2)(a)(b)
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102416.5(1)(2)(a)(b)For a Large

Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:

(1) Twelve children, no more than four of whom may be infants; or

(2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

(a) At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.

(b) No more than three infants are cared for during any time when more than 12 children are being cared for.
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Per the Licensee, 3 school age children was informed to leave the program on 10/18/21. Licensee will provide a letter or proof of children have been disenrolled from the program by 11/9/21.

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This requirement is not met as evidenced by record reviews, it was observed licensee had 1 infant, 5 preschool age children, and 11 school age children in care in September 2021. This poses an immediate health and safety risk to children in care.



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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: 10/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2