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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414000158
Report Date: 03/06/2024
Date Signed: 03/06/2024 05:28:13 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
02/15/2024 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240215135021
FACILITY NAME:HAPPY CAMPERS PRESCHOOL DAYCAREFACILITY NUMBER:
414000158
ADMINISTRATOR:AUDRA TSIVIKASFACILITY TYPE:
850
ADDRESS:510 LAUREL STREETTELEPHONE:
(650) 678-8244
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY:106CENSUS: 21DATE:
03/06/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Audra TsivikasTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff does not ensure facility sanitized and clean.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kassandra Medrano, conducted a subsequent site visit to the facility to deliver investigation findings. LPA met with Director, Audra, and the purpose of the visit was explained.

LPA Medrano interviewed staff, management. Based on interviews, observations, as well as information gathered; it was found that facility did not ensure facility is clean and sanitized. It was found that bathrooms are not kept clean and properly sanitized. The facility overall is lacking cleanliness in hall as well classrooms. LPA observed floors to be dirty and general disrepair throughout. Facility states they are currently in the process of change of location, and do not plan on making large repairs to the facility. An application has not been received by San Bruno regional office. The allegation noted above is thus found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
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 3
Control Number 05-CC-20240215135021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HAPPY CAMPERS PRESCHOOL DAYCARE
FACILITY NUMBER: 414000158
VISIT DATE: 03/06/2024
NARRATIVE
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LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH APPLICANT/PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

This TYPE A citation page shall be posted for 30 days along with the “Notice of Site Visit.” This page shall be provided to all parents of children currently enrolled, and any future children being enrolled for the next 12 months per AB 633 requirements.

California Code of Regulations, Title 22 TYPE A deficiencies are being cited on the following page(s):

Exit interview conducted and report was reviewed with director, Audra Tsivikas.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20240215135021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAPPY CAMPERS PRESCHOOL DAYCARE
FACILITY NUMBER: 414000158
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2024
Section Cited
CCR
101238(a)
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Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement was not met as evidenced by:
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Director to send documentation of cleaning plan, as they are hiring a janitorial staff.
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Based on interviews and observations facility did not ensure facility as well as childrens and staffs bathrooms and facility were kept clean and in good repair. This poses an immediate health and safety risk to children enrolled.
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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.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3