384002727-5-6-2021-05-CC-GLEG-C2S2QU-20210506173629

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002727
Report Date: 05/06/2021
Date Signed: 05/06/2021 02:58:19 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
01/29/2021 and conducted by Evaluator Farhan Bashir-Tariq

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210129154514

FACILITY NAME:	MARTIN LUTHER KING JR. CENTER		FACILITY NUMBER:	384002727
ADMINISTRATOR:	STANCIL, MADONNA		FACILITY TYPE:	850
ADDRESS:	200 CASHMERE STREET		TELEPHONE:	(415) 401-1377
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94124
CAPACITY:	38	CENSUS: 26	DATE:	05/06/2021
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Andrea Collier		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Child sustained unexplained injuries while in care.
Staff hit child while in care.
Inappropriate interactions between children while in care.
Staff interacted with day care child in a physically inappropriate manner.

INVESTIGATION FINDINGS:

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*** This report was prepared in CCLD Regional Office, San Bruno on 5/6/21. This inspection was completed via phone call due to COVID-19 restrictions. Director was informed that a copy of today’s report will be emailed to her .***

On 5/6/21 at 1:50 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq spoke to Director, Andrea Collier, to deliver the findings of this complaint investigation. Purpose of inspection was explained. During the course of investigation, LPA conducted an initial inspection with Director on 2/4/21 via phone. LPA also conducted subsequent on-site inspections on 3/23/21 and 4/26/21. As part of this investigation, LPA collected the following information from facility staff via emails: Facility Rosters, Email Communications, Personnel Report, Discipline Policy and Pictures. LPA interviewed RP, Director, Teachers, Admin Staff, Management, Parents and children to complete this investigation.

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: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

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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Control Number 05-CC-20210129154514

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: MARTIN LUTHER KING JR. CENTER	FACILITY NUMBER: 384002727
	VISIT DATE: 05/06/2021

NARRATIVE

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This agency has now investigated the complaint alleging the above allegations. Based on the information obtained, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No citations were issued on this report. This report must be available in the facility for public review. Facility was advised to call office for any additional questions, M-F, 8AM-5PM at 650-266-8800. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

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