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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005444
Report Date: 07/28/2021
Date Signed: 07/28/2021 04:09:39 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
03/24/2021 and conducted by Evaluator Farhan Bashir-Tariq
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210324134637
FACILITY NAME:MUNOZ, VICTORIA AND GARAY, JUANFACILITY NUMBER:
214005444
ADMINISTRATOR:MUNOZ, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 455-9621
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:14CENSUS: DATE:
07/28/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Victoria MunozTIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately touched daycare child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
*** This report was prepared in CCLD Regional Office, San Bruno due to COVID-19 restrictions in place. This inspection was conducted via phone call. Licensee was informed that a copy of today’s report will be emailed to her. Confirm receipt is required. ***

On 7/28/21 at 2:45 am., LPA called and spoke to Licensee to deliver the findings of this complaint investigation. Purpose of inspection was explained. There were no children present today. LPA made an initial visit on 3/25/21 to start the investigation and a subsequent visit today to deliver the findings. This case was referred to Department's Investigations Brach (IB). Investigations were carried out by Investigator, Jorge Martinez to determine the outcome of this allegation of staff inappropriately touched day care child. It was determined in IB's investigation that there is no information or evidence available to substantiate the allegation.

This agency has investigated the complaint alleging that staff inappropriately touched day care child. 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 deficiencies were cited on this report.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
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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