414000782-10-7-2021-05-CC-AZEA-C8PVDZ-20211112152131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414000782
Report Date: 10/07/2021
Date Signed: 10/07/2021 02:13:05 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
08/19/2021 and conducted by Evaluator Kassandra Medrano

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210819084235

FACILITY NAME:	GARCIA, MARIA MATILDE		FACILITY NUMBER:	414000782
ADMINISTRATOR:	GARCIA, MARIA MATILDE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 366-0732
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	14	CENSUS: 1	DATE:	10/07/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensee, Maria Garcia		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Licensee hit child in care
Child sustained unexplained injuries in care
Licensee handled child in rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kassandra Medrano conducted a subsequent unannounced complaint inspection, and met with Licensee, Maria Garcia. Present in the home is licensee, husband, and one child. During the course of the investigation, LPA conducted interviews, reviewed files, and collected pertinent documents.

Although the allegations may have happened or are valid, there is not a perponderance of evidence to prove the allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

NOTICE OF SITE VISIT WILL BE POSTED AND SHALL REMAIN POSTED FOR 30 DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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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