414002877-5-3-2019-05-CC-AMAG-BDCPJ3-20190621112049

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414002877
Report Date: 05/03/2019
Date Signed: 05/03/2019 10:06:06 AM

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
02/27/2019 and conducted by Evaluator Cindy Mok

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20190227145220

FACILITY NAME:	PFS-BAYSHORE MIDWAY CDC (PS)		FACILITY NUMBER:	414002877
ADMINISTRATOR:	MARISOL OSTORGA		FACILITY TYPE:	850
ADDRESS:	45 MIDWAY DRIVE		TELEPHONE:	(415) 330-1717
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY:	95	CENSUS: 85	DATE:	05/03/2019
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Crystal Plascencia		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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* Lack of Supervision resulting inappropriate interactions between children in care.

* Staff hit child in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mok conducted an unannounced inspection to finalize this complaint. LPA met with the Assistant Site Director, Crystal Plascencia. The purpose of the inspection was explained to her. There were 85 children with 15 staff present. During the investigation, LPA conducted interview with staff and witnesses. Based on the interviews, there was no sufficient evidence to prove staff hit the child in care and lack of supervision resulting insppropriate interactions between children in care.

Although the allegations may have happened or are valid, there was not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation was Unsubstantiated.

An exit inspection was conducted with Assistant Site Director and appeal rights were explained. A printed copy of the report, as well as a printed copy of the appeal rights, were provided to the Licensee at the conclusion of the inspection. Notice of site visit was posted and must remain posted for 30 days for public review.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019

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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