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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414000620
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:15:11 PM

Unsubstantiated


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
08/03/2022 and conducted by Evaluator Winnie Ly
COMPLAINT CONTROL NUMBER: 05-CC-20220803142508
FACILITY NAME:EARLY YEARS, THEFACILITY NUMBER:
414000620
ADMINISTRATOR:JOANNE MUSANTEFACILITY TYPE:
850
ADDRESS:371 ALLERTON AVENUETELEPHONE:
(650) 588-7525
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:90CENSUS: 24DATE:
09/21/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mary Flores (Acting Director)TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Staff did not properly supervise daycare child
2. Daycare child injured while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On September 21, 2022 at approximately 9:45am, Licensing Program Analyst (LPA) Winnie Ly conducted a conclusionary complaint visit at this location. LPA met with Acting Director Mary Flores. The purpose of the visit was explained. There were 6 staff including the Acting Director caring for 24 children.

Based on the information obtained during this investigation through reviewing records, interviewed staff and interviewed parents, there was no sufficient evidence to prove allegations (1) Staff did not properly supervise daycare child, (2) Daycare child injured while in care. 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 UNSUBSTANTIATED.

This report was reviewed with Acting Director whose signature confirm have read the report. A copy of this report and appeal rights were discussed and left with Acting Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was provided. Notice of Site Visit to remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
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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