384002300-5-8-2020-05-CC-AMAG-BPJMQU-20200512094912

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002300
Report Date: 05/08/2020
Date Signed: 05/08/2020 01:25:07 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
03/03/2020 and conducted by Evaluator Kassandra Medrano

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20200303142538

FACILITY NAME:	C5 CHILDREN'S SCHOOL-SFPUC (INF)		FACILITY NUMBER:	384002300
ADMINISTRATOR:	SHERAN LO		FACILITY TYPE:	830
ADDRESS:	525 GOLDEN GATE AVENUE		TELEPHONE:	(415) 703-1277
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY:	36	CENSUS: 0	DATE:	05/08/2020
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Director, Sheran Lo		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Comingling with Preschool Program
Facility Limiting Food

INVESTIGATION FINDINGS:

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On May 8th,2020 at 1:15pm, Licensing Program Analyst (LPA) Kassandra Medrano conducted an announced complaint investigation via phone call due to covid-19 and facility being closed today to deliver findings. LPA met with Director, Sheran Lo. The purpose of visit was explained to her, to deliver findings of above allegations.
As part of this investigation, staff were interviewed and children and staff as well as facility records were reviewed. LPA also conducted an evaluation of care and supervision of the children. As well as a review of the facilities order invoice for food. LPA observed room in question where child was said to have entered outdoor play area with preschool program. Where multiple staff state there is no possibility for child to push door open. LPA also observed as teachers served children food and asked if children would like more.
Based on interviews conducted and internal facility documentation reviewed, there was no substantial evidence to prove the above allegations did or not occur. Although the allegation may have happened or is 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 was reviewed with the Director and a copy was emailed to director. Notice of Site Visit was posted and must remain for the next 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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