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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005477
Report Date: 02/04/2022
Date Signed: 04/04/2022 01:30:04 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
01/05/2022 and conducted by Evaluator Haydee R Caliboso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220105145140
FACILITY NAME:HUMMINGBIRDS COLLABORATIVE SCHOOLFACILITY NUMBER:
214005477
ADMINISTRATOR:RICHARD, MELINDAFACILITY TYPE:
850
ADDRESS:1990 NOVATO BLVD.TELEPHONE:
(415) 760-6197
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:42CENSUS: 41DATE:
02/04/2022
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Melinda RIchardTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not following health directives to prevent the spread of COVID-19
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
*** Report Amended due to report date indicating 2/4/22. Report actually delivered on 3/16/22. ***

On 3/16/22 at 11:40AM, Licensing Program Analyst (LPA) Haydee Caliboso arrived at the facility to conduct a closing complaint investigation in response to the above allegation. LPA spoke with the Director, Melinda Richard. Present during the inspection were 41 children and 6 staff.

Based on LPA's gathered information through observations and interviews with parents enrolled in the program the agency has investigated the complaint allegation above. The facility did follow health directives to prevent the spread of COVID-19. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation in UNSUBSTANTIATED.

Appeal Rights were provided to the facility. This report and rights to comment and appeal have been discussed. A Notice of Site Visit was posted during this inspection.
Unsubstantiated
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: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
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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