384002299-8-17-2021-05-CC-AZEA-C5ZPK5-20210818112234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002299
Report Date: 08/04/2021
Date Signed: 08/17/2021 04:27:41 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
06/10/2021 and conducted by Evaluator Harsimran Kaur

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210610094356

FACILITY NAME:	C5 CHILDREN'S SCHOOL-SFPUC (PS)		FACILITY NUMBER:	384002299
ADMINISTRATOR:	ERIN FARRIS		FACILITY TYPE:	850
ADDRESS:	525 GOLDEN GATE AVENUE		TELEPHONE:	(415) 626-4880
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY:	45	CENSUS: 5	DATE:	08/04/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Erin Farris		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff was under the influence of alcohol while providing care and supervision to day care children.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On August 4th, 2021, at 08:30 AM Licensing Program Analyst (LPA) Kaur conducted an unannounced complaint visit to issue final findings. LPA met with Director Erin Farris and explained the purpose of the visit. Present during the visit were 2 infants and 3 teachers. During the course of the investigation, LPA reviewed records, conducted interviews, and obtained copies of pertinent documents. Information received indicate that staff (S1) was found under the influence of alcohol while providing care and supervision to day care children. However, interviews disclosed that there is no conclusive evidence at this time to prove that staff came to work under the influence of alcohol. 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. Based on the investigative findings, the complaint allegation is unsubstantiated.

An Exit Interview was conducted with Site Director. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and notice of site visit were discussed and left with Site Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov.

“This is an amendment of the original document dated 08/04/2021”

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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