380504369-11-3-2021-05-CC-CINO-C92PXD-20211123104206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 380504369
Report Date: 11/03/2021
Date Signed: 11/03/2021 04:09:13 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
10/05/2021 and conducted by Evaluator Catrina Quimbo

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20211005092916

FACILITY NAME:	ST. NICHOLAS DAY CARE AND PRESCHOOL		FACILITY NUMBER:	380504369
ADMINISTRATOR:	TUWAI, KATHY		FACILITY TYPE:	850
ADDRESS:	5200 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 550-1536
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	70	CENSUS: 37	DATE:	11/03/2021
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Director, Kathy Tuwai		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff hit child with an object.

INVESTIGATION FINDINGS:

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On November 3, 2021 at 8:40am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, complaint visit to St. Nicholas Day Care and Preschool. LPA met with director, Kathy Tuwai. The purpose of the visit was explained to director.

Facility is a combination center under two different licenses. Under preschool license, there are 3 classrooms in use with 37 children and 8 staff members (including director) present.

As part of this complaint investigation, interviews were conducted, and documents were reviewed and obtained. Interviews conducted did not state a child whom attended facility was ever or has ever been hit with an object while at facility.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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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Control Number 05-CC-20211005092916

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: ST. NICHOLAS DAY CARE AND PRESCHOOL	FACILITY NUMBER: 380504369
	VISIT DATE: 11/03/2021

NARRATIVE

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Although the above allegation may have happened or is valid, based on LPA’s interviews and record review which were conducted, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

After today’s visit, an exit interview was conducted with director, Kathy Tuwai. Upon receipt of this report, director shall post the Notice of Site Visit. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC9099 (FAS) - (06/04)

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