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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410518747
Report Date: 01/20/2022
Date Signed: 01/20/2022 04:55:12 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
11/09/2021 and conducted by Evaluator Leslit Tapia-Mandujano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211109140636
FACILITY NAME:RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOLFACILITY NUMBER:
410518747
ADMINISTRATOR:PENA, ROXANAFACILITY TYPE:
850
ADDRESS:701 CHARTER ST, PORT 1,2,3,& 4TELEPHONE:
(650) 482-2407
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:105CENSUS: 34DATE:
01/20/2022
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Site Supervisor: Roxana PenaTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff member inappropriately handled day care child.
INVESTIGATION FINDINGS:
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On 1/20/22, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced inspection to deliver findings and close complaint. LPA met with Site Supervisor, Roxana Pena and explained the purpose of the inspection. Complaint was received by the Department on 11/02/21. Present in the facily are 11 staff caring for 34 children. All staff have fingerprint clearance through the Shool District.

During today's visit, LPA interviewed staff and Site Supervisor.

During the course of the investigation, review of facility records, physical plant, and interviews were conducted. LPA also obtained other pertinitent docuemtation.

Based on interviews and pertinent information, it has been confirmed that a Staff member inappropriately handled a day care child. Therefore, the preponderance of evidence standard has been met, there for the above allegation is found to be SUBSTANTIATED.

***See attached page for deficiencies cited against the facility under CCR,Title 22, Div. 12, Chapt. 1.***

Report was reviewed and discussed with Site Supervisor, Roxana Pena. A copy of this report was emailed to Prinicipal, Edna Carmona at ecarmona@rcsdk8.net
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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 2
Control Number 05-CC-20211109140636
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: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL
FACILITY NUMBER: 410518747
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2022
Section Cited
CCR
101223(a)(1)
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101223(a)(1): Personal Rights: The licensee shall ensure that each child is accorded the following personal rights:To be accorded dignity in his/her personal relationships with staff and other persons.
The requirement is not met as evidenced by.
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Facility will have an all staff training given by an outside vendor on/around the topic of Personal Rights of Children.
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Based on interviews and investigation, it was determined that a staff member inappropriately handeled a day care child. This poses a potential health and safety risk to children in care.
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Facility will show proof of completion to LPA Tapia-Mandujano by 2/18/22.
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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) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2