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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384000529
Report Date: 09/26/2019
Date Signed: 09/26/2019 04:11:12 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
08/30/2019 and conducted by Evaluator Farhan Bashir-Tariq
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20190830151832
FACILITY NAME:FERNANDEZ, ANA M.FACILITY NUMBER:
384000529
ADMINISTRATOR:FERNANDEZ, ANA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 641-8711
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:14CENSUS: 6DATE:
09/26/2019
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Ana FernandezTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Licensee hits day care child.
Licensee yells at day care child.
Licensee will not allow parents into the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Farhan Bashir-Tariq arrived at the facility unannounced to meet Licensee Ana Fernandez to deliver the findings of the complaint investigation. This was a follow up visit from previous visits of 9/06/19 and 9/13/19. Purpose of the inspection was explained. Present there were 6 children with the Licensee and one Helper, Veronica Aguilar. Background check clearance is already on file for Licensee and Helper. The facility is operating within licensed capacity and ratio limits as of today 9/26/19.

During the course of this investigation, LPA made an initial visit and a subsequent visit to interview Licensee and Daughter, Gabriela. As part of this investigation , LPA collected facility roster and contact details of the parents. LPA interviewed a number of parents regarding the allegations. From the interviews conducted and information collected during the investigation, LPA did not receive an indication that the allegations of Licensee hit and yelled at a day care child occurred at the day care and that Licensee will not allow parents into the facility.
Continuation on next page...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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-20190830151832
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: FERNANDEZ, ANA M.
FACILITY NUMBER: 384000529
VISIT DATE: 09/26/2019
NARRATIVE
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This agency has investigated the complaint alleging that Licensee hit and yelled at a day care child and Licensee will not allow parents into the facility. Based on the information obtained, 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 allegation is UNSUBSTANTIATED.


No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations. This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2