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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214200002
Report Date: 11/12/2020
Date Signed: 11/12/2020 04:08:46 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
08/31/2020 and conducted by Evaluator Farhan Bashir-Tariq
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20200831082927
FACILITY NAME:GUEDEZ, AURA MARINAFACILITY NUMBER:
214200002
ADMINISTRATOR:GUEDEZ, AURA MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 479-1913
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:14CENSUS: 7DATE:
11/12/2020
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Aura Marina GuedezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained injury while in care.
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 on 11/12/20. This inspection was conducted via phone call due to COVID-19. Licensee was informed that a copy of today’s report will be emailed to her *****

Licensing Program Analyst (LPA), Farhan Bashir-Tariq called and spoke to Licensee to deliver the findings of this complaint investigation on 11/12/20. Purpose of inspection was explained. During the course of investigation, interviews were conducted with Licensee, Staff, Mother of injured child and Parents of other children. Facility roster and Personnel records were also collected from Licensee after the initial visit via email. It was determined during the investigation that child was being supervised in home when incident occurred. Thus, it does not lead to a point where it can be established that Licensee was in breach of any regulation.

This agency has investigated the complaint alleging that day care child sustained injury while in care. 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.
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: 11/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2020
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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