214005476-11-20-2019-05-CC-GLEG-BLGQBH-20200204110133

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 214005476
Report Date: 11/20/2019
Date Signed: 11/20/2019 12:10:15 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
11/18/2019 and conducted by Evaluator Farhan Bashir-Tariq

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20191118100123

FACILITY NAME:	LIMA, BRUNA R.		FACILITY NUMBER:	214005476
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 8	DATE:	11/20/2019
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Bruna Lima		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is over capacity.
Licensee is operating beyond the terms of license.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPAs) Farhan Bashir-Tariq and Luis Gomez arrived at the facility unannounced to conduct a complaint investigation. Purpose of the inspection was explained. Present there were 8 children in care (4 Infants and 4 Preschoolers) with the Licensee. Background check clearance is already on file for Licensee and adults living or working in the home.

During the course of this investigation, LPAs reviewed the facility files and recorded names and date of births of the children present today. As part of this investigation , LPAs collected a copy of the facility roster. Based on LPAs observation and record’s reviewing, it was evident that Licensee is operating out of ratio by caring for 4 infants and 4 preschoolers at the same time on this day.

Substantiated

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: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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 3

Control Number 05-CC-20191118100123

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: LIMA, BRUNA R.	FACILITY NUMBER: 214005476
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/21/2019 Section Cited CCR 102416.5(b)(1)(2)(3)	1 2 3 4 5 6 7	102416.5…Staffing Ratio and Capacity. (b)For a Small Family Child Care Home, the maximum number of children...shall be one of the following: (1) Four infants; or (2) Six children, no more than three of whom may be infants; or (3) More than six and up to eight children, ... health and Safety Code are met. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Licensee will lower her capacity an make the schedule changes to stay within the licensed ratio limits. A subsequent visit will be made by LPA to check the ratio.
	8 9 10 11 12 13 14	Based on the observation and records reviewed today, Licensee did not meet the requirement by caring for 4 infants and 4 preschoolers at the same time. This poses an immediate health and safety risk to the children in care.	8 9 10 11 12 13 14	LPA explained the capacity and ratio limits of small FCCH to the Licensee and provided handouts.
	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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 05-CC-20191118100123

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: LIMA, BRUNA R.	FACILITY NUMBER: 214005476
	VISIT DATE: 11/20/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on LPAs observation and record’s reviews today, the preponderance of evidence standard has been met, therefore the above allegations were found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 3), were being cited on the attached LIC 9099D.

Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file. A copy of the Form LIC 9224 was provided to the Licensee.

An exit interview was conducted with Licensee and appeal rights were explained. A printed copy of the report, as well as appeal rights of the inspection were given to Licensee. Notice of site visit was posted and must remain posted for 30 days for public review.

Licensee was advised any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 3