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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380506430
Report Date: 12/10/2021
Date Signed: 12/10/2021 11:43:40 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
10/22/2021 and conducted by Evaluator Catrina Quimbo
COMPLAINT CONTROL NUMBER: 05-CC-20211022140450
FACILITY NAME:ST. PAUL'S CHURCH-LITTLEST ANGEL PREPARATORY PRESCFACILITY NUMBER:
380506430
ADMINISTRATOR:BALUYUT, MA CONCEPCIONFACILITY TYPE:
850
ADDRESS:221 VALLEY STREET, ROOM XTELEPHONE:
(415) 824-5437
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:38CENSUS: 0DATE:
12/10/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Director, Concepcion BaluyutTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff handled child in a rough manner
Child sustained injury while in care
Staff did not provide adequate care and supervision to child in care
INVESTIGATION FINDINGS:
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On December 10, 2021 at 11:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a complaint visit to St. Paul’s Church-Littlest Angel Preparatory Preschool regarding above allegations. LPA met with director, Concepcion “Tina” Baluyut. The purpose of the visit was explained.

Present during visit was director. As part of this complaint investigation, LPA conducted facility observations, interviews with random selection of enrolled children’s parents, and interviews with all teaching staff.

During facility observations, LPA did not observe teaching staff to be handling children in care in a rough manner. Random selection of parents interviewed stated teaching staff handle children with care and have observed staff providing constant supervision to enrolled children. During staff interviews, staff stated children are not handled in a rough manner and are constantly supervised.

(Continue on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 05-CC-20211022140450
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
VISIT DATE: 12/10/2021
NARRATIVE
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(Continued, Page 2)

Although the above allegation may have happened or is valid, based on LPA’s observations and interviews 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, Ma Concepcion “Tina” Baluyut. 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 InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2