414002946-9-28-2023-05-CC-DJOO-CWCTH8-20231006144417

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414002946
Report Date: 09/28/2023
Date Signed: 09/28/2023 04:09:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
05/15/2023 and conducted by Evaluator Andrea Medlin

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20230515155236

FACILITY NAME:	TRINITY LUTHERAN PRESCHOOL		FACILITY NUMBER:	414002946
ADMINISTRATOR:	EYVAZOV, JAM		FACILITY TYPE:	850
ADDRESS:	1505 SHERMAN AVENUE		TELEPHONE:	(650) 580-2349
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	28	CENSUS:	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Jam Eyvazov		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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PERSONAL RIGHTS: Staff engaged in inappropriate interactions with child in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this conclusionary complaint visit. Purpose of visit explained. Initial complaint investigation was conducted on 5/24/2023 by LPA Andrea Medlin; LPA obtained a children's roster and staff roster with contact information. This complaint investigation was handled and investigated by our Investigations Bureau (IB) and they conducted all subsequent visits, gathered information, conducted interviews, as well as obtained supplemental reports.

Based on the Department's Investigation Bureau (IB), it was determined there was a lack of sufficient evidence to support or deny the allegations. Based on this information, the findings of these allegations are unsubstantiated.

This report was reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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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