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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380506430
Report Date: 07/12/2019
Date Signed: 07/12/2019 03:15:39 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
05/14/2019 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20190514172051
FACILITY NAME:ST. PAUL'S CHURCH-LITTLEST ANGEL PREPARATORY PRESCFACILITY NUMBER:
380506430
ADMINISTRATOR:LAZZARINI, MARGARETFACILITY TYPE:
850
ADDRESS:221 VALLEY STREET, ROOM XTELEPHONE:
(415) 824-5437
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:38CENSUS: 21DATE:
07/12/2019
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director, Margaret LazzariniTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility is unsanitary


INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Luis J. Gomez conducted a complaint investigation inspection today to investigate the above allegation. As part of this investigation, LPA Gomez conducted an evaluation of the building and grounds, performed site observation and interviewed children, staff and director that work in the facility. During today's inspection, LPA Gomez interviewed the site director and children. Based interviews which were conducted, and observations made the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, Chapter 1), are being cited on the attached LIC 9099D. A copy of this report and rights to appeal were reviewed and provided to staff. Notice of Site Visit was observed to be posted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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-20190514172051
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. PAUL'S CHURCH-LITTLEST ANGEL PREPARATORY PRESC
FACILITY NUMBER: 380506430
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2019
Section Cited
CCR
101223(a)(2)
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101223(a)(2) Personal Rights. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Facility must submit a plan of correction, to keep dog in off limit areas be approved by licensing by the due date: 8/2/2019.

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This requirement is not met as evidenced by director's dog, urinating in the bathroom/ daycare area. This presents a immediate health and safety risks to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2