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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002202
Report Date: 10/12/2022
Date Signed: 10/12/2022 11:48:35 AM

Unsubstantiated


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
10/05/2022 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20221005151540
FACILITY NAME:FACESSF - HAYES VALLEY CDC (INFANT)FACILITY NUMBER:
384002202
ADMINISTRATOR:KIMBERLY WONGFACILITY TYPE:
830
ADDRESS:305 BUCHANAN STREETTELEPHONE:
(415) 552-1535
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:18CENSUS: 14DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Stephanie KuyperTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Staff did not provide proper supervision resulting in day care child biting other day care child(ren) while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Andrea Medlin conducted a complaint investigation at facility. LPA met with facility representative. Purpose of visit explained. Information gathered and interviews conducted regarding allegation. Based on information obtained, there is a child (C1) who has had some incidents of biting behavior that involved C1 biting other children. The child who is biting is in the "toddler" portion of classroom. Methods are being used to redirect child from the biting such as having a staff person "shadow" child and special "teething toys" have been given to child. This seems to have helped improve the behavior recently. Despite interventions, C1 was able to bite another child recently which caused some concern to the family involved regarding the child that was bitten. Based on what was gathered, this does not appear to have been the result of lack of supervision, just that C1 does it randomly and in an instant before staff can intervene. Due to lack of sufficent available information regarding specifics to the complaint, there is not enough evidence to prove whether the incident was the result of lack of supervision.

(continued on next page 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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-20221005151540
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: FACESSF - HAYES VALLEY CDC (INFANT)
FACILITY NUMBER: 384002202
VISIT DATE: 10/12/2022
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of site visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2