410505762-8-26-2021-05-CC-GLEG-C8SQY4-20211115113428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 410505762
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:54:30 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
08/17/2021 and conducted by Evaluator Marie Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210817125050

FACILITY NAME:	INTERCOMMUNAL SURVIVAL SCHOOL		FACILITY NUMBER:	410505762
ADMINISTRATOR:	CAMACHO, MELINDA ANN		FACILITY TYPE:	850
ADDRESS:	713 SECOND AVENUE		TELEPHONE:	(650) 347-0463
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	29	CENSUS: 17	DATE:	08/26/2021
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Director Melinda "Mindy" Camacho		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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- Staff handle children in rough manner.
- Staff yell at and uses profanity around children.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced complaint inspection to open a complaint. LPA met with staff and explained purpose of inspection. Director Melinda "Mindy" Camacho arrived a short time later. Present at center were the Director, four teachers, and 17 children.

LPA conducted a physical plant tour with staff. LPA conducted interviews and reviewed pertinent documents. LPA made observations while children were indoors and outdoors. During this time period, LPA did not observe any staff handling children in a rough manner. LPA did not observe any staff yelling or using profanity around children.

Although the allegations 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 allegations are closed as UNSUBSTANTIATED.

Report was reviewed and discussed with Director Mindy Camacho. A copy of report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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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