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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384001053
Report Date: 01/05/2022
Date Signed: 01/05/2022 09:43:57 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
10/20/2021 and conducted by Evaluator Jennifer Yee
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211020123425
FACILITY NAME:SHEEHAN, KERIFACILITY NUMBER:
384001053
ADMINISTRATOR:SHEEHAN, KERIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 531-9376
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY:14CENSUS: 2DATE:
01/05/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Keri SheehanTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Neglect/Lack of Supervision-Daycare child sustained an unexplained injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, LPA Yee conducted a visit to deliver this complaint. The purpose of the inspection was explained. There are 2 infants, licensee and helper present today. The Department's Investigation Branch (IB) has investigated this complaint and determined the finding to be substantiated.

On 10/15/2021, a child sustained a severed toe; Licensee Keri was not inside the room when that happened. The assistant was inside the room holding/feeding an infant and saw from the corner of his eye an unknown object thrown across the room. Based on the Department's investigation, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, (Title 22, Div 12 Chp3), are being cited on the attached LIC9099d. See next page for Type A citation and $500 civil penalty.

The facility was advised to post and provide copies of this report to parents and guardians of children in care at the facility and parents/guardians of children newly enrolled at the facility during the next 12 months. All parents shall sign the LIC 9224 as proof of receipt. Appeal Rights was provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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 3
Control Number 05-CC-20211020123425
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: SHEEHAN, KERI
FACILITY NUMBER: 384001053
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/06/2022
Section Cited
CCR
102423(a)(2)
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102423(a)(2), Personal Rights:Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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The facility needs to provide a plan of corrections by 1/6/2022.
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The child sustained an injury wihile in care due to lack of supervision.

This requirement is not met as evidenced by medical records and IB investigation. This poses an immediate safety risk to children in care.
Civil penalty of $500 was issued today.
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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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
10/20/2021 and conducted by Evaluator Jennifer Yee
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211020123425

FACILITY NAME:SHEEHAN, KERIFACILITY NUMBER:
384001053
ADMINISTRATOR:SHEEHAN, KERIFACILITY TYPE:
810
ADDRESS:1634 FELL STREETTELEPHONE:
(415) 531-9376
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY:14CENSUS: DATE:
01/05/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Keri SheehanTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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9
Neglect/Lack of Supervision-Licensee did not seek medical treatment for daycare child
INVESTIGATION FINDINGS:
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Licensing Program Analyst, LPA Yee conducted a visit to deliver this complaint. The purpose of the inspection was explained. There are two infants, licensee and helper present today. The Department's Investigation Branch (IB) has investigated this complaint and determined the finding to be unsubstantiated. Licensee, Keri was not present inside the room at the time of the incident. The licensee stated that she called the child's father and the child's father didn't pick up the phone. She then called 911; 911 did not pick up. At the same time, the child's father called and she picked up the calls. The child's father stated that the licensee did not call 911.

Due to inconsistent given statements, it cannot be proven or disproven regarding any violations.

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".

This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3