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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002757
Report Date: 11/15/2021
Date Signed: 11/15/2021 04:36:14 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
09/16/2021 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210916152106
FACILITY NAME:SF TIKES ACADEMYFACILITY NUMBER:
384002757
ADMINISTRATOR:SHIMKUNAS, SARAHFACILITY TYPE:
850
ADDRESS:1218 SOUTH VAN NESS AVENUETELEPHONE:
(415) 826-8222
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:117CENSUS: 61DATE:
11/15/2021
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Sarah ShimkunasTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Unqualified staff working at daycare.
INVESTIGATION FINDINGS:
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On 11/15/2021 at 11:05A.M., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Sarah Shimkunas at the facility. Purpose of inspection was explained and was for complaint investigation to report findings. Present was Director and 8 staff supervising 61 children. All staff had proper criminal record clearances on file. LPA inspected facility with director for health and safety hazards.

During inspection, LPA performed site observations, interviewed staff and reviewed facility records.

During the course of the investigation, site observations were conducted on 11/3/2021 and 11/15/2021. A review of the facility records was completed, which included the children’s files, staff files, personnel rosters (LIC500) and updated parent handbook. LPA conducted interviews with the Site Director, Staff, Sample of Parents and all involved parties. Regarding allegation of unqualified staff working at the day-care; Based on interviews, observations and record review, LPA confirmed teachers aide, left alone without proper qualification. (REFER TO lLIC9099C FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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 6
Control Number 05-CC-20210916152106
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: SF TIKES ACADEMY
FACILITY NUMBER: 384002757
VISIT DATE: 11/15/2021
NARRATIVE
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(Page 2)
Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation(s) are found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1 are being cited on the attached 9099-D.) Appeal Rights were provided to the facility.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment and appeal have been discussed.

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
09/16/2021 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210916152106

FACILITY NAME:SF TIKES ACADEMYFACILITY NUMBER:
384002757
ADMINISTRATOR:SHIMKUNAS, SARAHFACILITY TYPE:
850
ADDRESS:1218 SOUTH VAN NESS AVENUETELEPHONE:
(415) 826-8222
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:117CENSUS: 61DATE:
11/15/2021
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Sarah ShimkunasTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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9
Staff did not properly supervise children during napping
Staff spoke inappropriately to daycare child
INVESTIGATION FINDINGS:
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On 11/15/2021 at 11:05A.M., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Sarah Shimkunas at the facility. Purpose of inspection was explained and was for complaint investigation to report findings. Present was Director and 8 staff supervising 61 children. All staff had proper criminal record clearances on file. LPA inspected facility with director for health and safety hazards.

During inspection, LPA performed site observations, interviewed staff and reviewed facility records.

During the course of the investigation, site observations were conducted on 11/3/2021 and 11/15/2021. A review of the facility records was completed, which included the children’s files, staff files, personnel rosters (LIC500) and updated parent handbook. LPA conducted interviews with the Site Director, Staff, Sample of Parents and all involved parties. (REFER TO LIC9099 FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 05-CC-20210916152106
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: SF TIKES ACADEMY
FACILITY NUMBER: 384002757
VISIT DATE: 11/15/2021
NARRATIVE
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(Page 2)
Regarding allegation of Staff did not properly supervise children during napping; Based on interviews, LPA was unable to determine if staff did not properly supervise children. During interviews, staff reported closing eyes momentarily during nap time. LPA issued Advisory Note: Technical Violation (LIC9102) during inspection.

Regarding the allegation of Staff spoke inappropriately to day-care child; Based on interviews and observations, LPA was unable to determine of staff spoke inappropriately to day-care child. During site inspection, LPA observed staff using appropriate language and tones.

Although the allegation(s) may have happened or is valid, the preponderance of evidence to prove alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies were cited.

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 05-CC-20210916152106
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: SF TIKES ACADEMY
FACILITY NUMBER: 384002757
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited
CCR
101216.2(d)(2)
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101216.2(d)(2) Teacher Aide Qualification: Completion of at least two post secondary semester units or equivalent quarter units in early childhood education or child development each semester or quarter following initial employment... This requirement is not met as evidenced by:
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Staff member is not present in the facility.

Updated staff schedule was provided to the Department on 11/15/2021.

Deficiency has been cleared.
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Based on interviews, observations and record review, LPA confirmed teachers aide, left alone, without proper qualification. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6