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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380504369
Report Date: 04/16/2020
Date Signed: 04/16/2020 10:58:31 AM



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
01/16/2020 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20200116145427
FACILITY NAME:ST. NICHOLAS DAY CARE AND PRESCHOOLFACILITY NUMBER:
380504369
ADMINISTRATOR:TUWAI, KATHYFACILITY TYPE:
850
ADDRESS:5200 DIAMOND HEIGHTS BLVD.TELEPHONE:
(415) 550-1536
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:70CENSUS: DATE:
04/16/2020
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
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9
Staff failed to provide a copy of required licensing reports to day-care parents.
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
10
11
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13
Due to COVID-19, a field visit is suspended at this time. This closing complaint is delivered by U.S. mail.

During the course of the investigation, and previous licensing visit on 1/24/2020, Licensing Program Analyst (LPA) Andrea Medlin reviewed with director, the requirements for when it is required to give parents/legal guardians a copy of licensing reports. Information was obtained and revieiwed including children's roster, copies of LIC 9224 signed by some parents. According to director, some parent's refused to sign a LIC 9224, however according to director, they were given a copy of reports that was instructed to give. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2020
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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