384002350-11-24-2020-05-CC-GLEG-BWEUSH-20201218145023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002350
Report Date: 11/24/2020
Date Signed: 11/24/2020 04:11:45 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
09/24/2020 and conducted by Evaluator Farhan Bashir-Tariq

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20200924105842

FACILITY NAME:	UCSF KIRKHAM CDC (PS)		FACILITY NUMBER:	384002350
ADMINISTRATOR:	NANCY TRINH COSTANTIELLO		FACILITY TYPE:	850
ADDRESS:	10 KIRKHAM STREET		TELEPHONE:	(415) 664-1217
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94143
CAPACITY:	93	CENSUS: 47	DATE:	11/24/2020
		UNANNOUNCED	TIME BEGAN:	03:22 PM
MET WITH:	Nancy Costantiello		TIME COMPLETED:	03:42 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Day care child sustained injuries by staff.

INVESTIGATION FINDINGS:

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

***** This report was prepared in CCLD Regional Office, San Bruno on 11/24/20. This inspection was conducted via phone call due to COVID-19. Director was informed that a copy of today’s report will be emailed to her *****

Licensing Program Analyst (LPA), Farhan Bashir-Tariq called and spoke to Director, Nancy Costantiello to deliver the findings of this complaint investigation on 11/24/20. Purpose of inspection was explained. During the course of investigation, interviews were conducted with Parents, Staff, Director and RP. Licensing had also consulted this case with a medical professional. As part of this investigation, facility roster, discipline policy, teacher’s schedule and statements and child pictures were also collected from facility after initial visit of 9/25/20. After completing the investigation, LPA did not have enough evidence to determine that injuries were caused by staff.

This agency has investigated the complaint alleging that day care child sustained injuries by staff. 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

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 1