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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384000532
Report Date: 02/09/2022
Date Signed: 02/09/2022 10:17:58 AM

Substantiated


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
12/30/2021 and conducted by Evaluator Winnie Ly
COMPLAINT CONTROL NUMBER: 05-CC-20211230083344
FACILITY NAME:EHRLICH, EVELINAFACILITY NUMBER:
384000532
ADMINISTRATOR:EHRLICH, EVELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 407-9257
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:14CENSUS: 8DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Evelina EhrichTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility is not following COVID-19 guidelines.
INVESTIGATION FINDINGS:
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On February 09, 2022, at approximately 9:30am, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Visit to this family child care home and met with Licensee Evelina Ehrich to deliver complaint finding. Purpose of visit was explained. Present during the visit were licensee and two assistants caring for 3 infants and 5 preschoolers.

Based on LPA's gathered information through observations and interviews, the agency has investigated the complaint allegation above. The facility failed to comply with a state or local COVID-19 public health order and CDSS COVID-19 guidelines. The preponderance of evidence standard has been met. The above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22,Division 12 & Chapter 1, are being cited on the attached LIC 9099D.

This report have been discussed and reviewed with licensee whose signature confirmed have read the report. A copy of this report and LIC 9099D will be emailed to licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
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-20211230083344
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: EHRLICH, EVELINA
FACILITY NUMBER: 384000532
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2022
Section Cited
CCR
101223(a)(2)
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101223(a)(2)Personal Rights:
(a)The licensee shall ensure that each child is accorded the following personal rights:

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:

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The staff will wear face covering when providing care to children regardless of staff's vaccination status. The facility will comply required by the CA Dept. of Public Health guidance and CDSS guidance on the use of face coverings. Licensee must review and be aware of the health guidance set forth by CA Dept. of Public Health Guidance on the Use of Face Coverings in a child care Facility.
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Based on observation and interviews conducted, the staff of the facility did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of persons in care. Staff did not wear face coverings while in the facility, as required by the CA Dept. of Public Health Guidance on the Use of Face Coverings in a child care facility. This poses a potential risk to children in care.
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Licensee will submit a statement sign by licensee and assistants certifying have reviewed and awared of the Guidance on the Use of Face Covering in Child Care Facility by 02/23/3022.
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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.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2