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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414001188
Report Date: 09/21/2021
Date Signed: 09/21/2021 12:51:01 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
08/11/2021 and conducted by Evaluator April Cowan
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210811161629
FACILITY NAME:BORDESSA, JODY D.FACILITY NUMBER:
414001188
ADMINISTRATOR:BORDESSA, JODY D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 359-2683
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:14CENSUS: 12DATE:
09/21/2021
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Jody BordessaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
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9
Staff did not change child's diaper appropriately resulting in a rash
INVESTIGATION FINDINGS:
1
2
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9
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13
On September 21, 2021 at 11:20 AM, Licensing Program Analyst (LPA) April Cowan met with licensee, Jody Bordessa, for an unannounced subsequent complaint inspection. The purpose of inspection was explained to licensee. Present in the facility is licensee and helper Laura Bordessa caring for 12 children (2 infants and 10 preschoolers).

In today’s inspection, LPA along with licensee inspected for health and safety hazards. LPA observed no deficiencies during inspection.

During the course of investigation, interviews were conducted with Licensee and parents. LPA did not find any parents that had children that were not cleaned and cared for upon pick up. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
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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