414002134-2-23-2021-05-CC-GLEG-BYJSLL-20210224125828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414002134
Report Date: 02/23/2021
Date Signed: 02/23/2021 03:11:47 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
07/30/2020 and conducted by Evaluator Andrea Medlin

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20200730171021

FACILITY NAME:	LOPEZ, JACQUELINE		FACILITY NUMBER:	414002134
ADMINISTRATOR:	LOPEZ, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 583-1374
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	14	CENSUS:	DATE:	02/23/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jacqueline Lopez		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Day-care child is being sexually abused while in care

INVESTIGATION FINDINGS:

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Due to the current COVID-19 pandemic, a field visit is suspended at this time.

Licensing Program Analyst (LPA) Andrea Medlin completed the complaint investigation report. This investigation was assisted by our Department's Investigation Branch (IB). LPA conducted the initial complaint investigation on 8/4/2020. At that time information was requested relevant to the allegation. The investigation determined there is not a sufficienct amount of evidence to prove a daycare child was sexually abused. Based on information gathered from the Investigation Branch (IB) and information obtained from LPA, it is unknown whether the alleged violation did or did not occur.

(continued on next page 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021

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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Control Number 05-CC-20200730171021

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: LOPEZ, JACQUELINE	FACILITY NUMBER: 414002134
	VISIT DATE: 02/23/2021

NARRATIVE

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The investigation determined there is not enough available sufficient information provided in complaint to prove sexual abuse.

Although these allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore these allegations are closed as unsubstantiated.

This report is reviewed with Licensee and a copy of this report must be made available for public review upon request. This report is provided to licensee through email.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021

LIC9099 (FAS) - (06/04)

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