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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002300
Report Date: 10/22/2019
Date Signed: 10/22/2019 01:46:21 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
09/30/2019 and conducted by Evaluator Brendon Van
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20190930105433
FACILITY NAME:C5 CHILDREN'S SCHOOL-SFPUC (INF)FACILITY NUMBER:
384002300
ADMINISTRATOR:SHERAN LOFACILITY TYPE:
830
ADDRESS:525 GOLDEN GATE AVENUETELEPHONE:
(415) 703-1277
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:36CENSUS: 33DATE:
10/22/2019
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sheran LoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
-Facility is operating out of ratio
-Infants were given food to which they are allergic
INVESTIGATION FINDINGS:
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 On 10/22/19 at 12:50 P.M., Licensing Program Analyst (LPA) Van conducted an unannounced subsequent complaint investigation and met with director, Sheran Lo. LPA explained the purpose of the inspection and was granted entry to the facility by the director. Present there are 33 infants and 14 teachers. Facility is operating within teachers/children ratio.
LPA and director inspected the facility for health and safety hazards. As part of this complaint investigation, complainant, teachers, and director were interviewed; records and relevant information were reviewed. On the first allegation where facility is operating out of ratio, LPA received conflicting information from teachers and complainant during the interview. Based on interview, teachers were aware of the infant/teacher ratio requirements. Teachers mentioned they would be communicating with other teachers and seeking help when they are out of ratio. In addition, teachers’ schedules revealed that facility had more than sufficient teachers to infants’ ratio.
On the second allegation where infants were given food to which they were allergic to, LPA found that there was a mistake made by the third-party food delivery company Chefables. Teachers’ interview revealed that normally C1 and C2 would receive a separate container when the food contains dairy product, and when there are no separate containers the food does not contain dairy product and it was okay for the children to consume. Information obtained confirm that on that particular day Chefables did not have any separate food for the children, and the primary teacher followed the school protocols and gave the food to the children. Moving forward, director stated she had requested Chefables to provide a monthly menu with ingredients as a preventable measure to avoid incident like this from occur again.
This agency has investigated the complaint alleging that the facility is operating out of ratio and infants were given food to which they were allergic to. Based on the information obtained, although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.
An exit interview was conducted with director. This report, and rights to comment were discussed with director. 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.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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-20190930105433
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: C5 CHILDREN'S SCHOOL-SFPUC (INF)
FACILITY NUMBER: 384002300
VISIT DATE: 10/22/2019
NARRATIVE
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On the second allegation where infants were given food to which they were allergic to, LPA found that there was a mistake made by the third-party food delivery company Chefables. Teachers’ interview revealed that normally C1 and C2 would receive a separate container when the food contains dairy product, and when there are no separate containers the food does not contain dairy product and it was okay for the children to consume. Information obtained confirm that on that particular day Chefables did not have any separate food for the children, and the primary teacher followed the school protocols and gave the food to the children. Moving forward, director stated she had requested Chefables to provide a monthly menu with ingredients as a preventable measure to avoid incident like this from occur again.

This agency has investigated the complaint alleging that the facility is operating out of ratio and infants were given food to which they were allergic to. Based on the information obtained, 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.

An exit interview was conducted with director. This report, and rights to comment were discussed with director. 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) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2