214200039-11-22-2021-05-CC-GLEG-C9CRNB-20211203121000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 214200039
Report Date: 11/22/2021
Date Signed: 11/22/2021 05:22:51 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
09/28/2021 and conducted by Evaluator Farhan Bashir-Tariq

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210928083138

FACILITY NAME:	CHAN-ROSADO, BEATRIZ		FACILITY NUMBER:	214200039
ADMINISTRATOR:	CHAN-ROSADO, BEATRIZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 459-5845
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	14	CENSUS: 12	DATE:	11/22/2021
		UNANNOUNCED	TIME BEGAN:	04:40 PM
MET WITH:	Beatriz Chan-Rosado		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Provider yelled at day care child.
Day care child's diapering needs were not met.
Provider denied toilet access to day care child.

INVESTIGATION FINDINGS:

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On 11/22/21 at 4:30 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to deliver the findings of this complaint investigation. Purpose of inspection was explained. There were 12 children present today with Licensee and Husband, Antonio Chimal. All adults living or working in the home have fingerprints clearance on file. Facility was working in compliance to staff and children ratio on this day. LPA conducted a virtual visit of facility on 10/06/21, a subsequent onsite inspection on 11/16/21 and a final visit today to deliver the findings of this complaint. During the course of investigation, LPA conducted interviews with Licensee, children and parents. As part of this investigation, copies of the following documents were received from Licensee : facility roster.

This agency has investigated the complaint alleging the allegations above. 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 citations were issued on this report. This report must be available in the facility for public review. Facility was advised to call office for any additional questions, M - F, 8 AM-5 PM at 650-266-8800. Website: www.cdss.ca.gov

End of Report.

Unsubstantiated

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: 11/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021

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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