414004024-2-25-2021-05-CC-GLEG-BYM3Y7-20210226173928

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414004024
Report Date: 02/25/2021
Date Signed: 02/25/2021 04:32:30 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
11/25/2020 and conducted by Evaluator Andrea Medlin

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20201125103822

FACILITY NAME:	AQUINO, ANNABELLE		FACILITY NUMBER:	414004024
ADMINISTRATOR:	AQUINO, ANNABELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 734-6514
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	14	CENSUS:	DATE:	02/25/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Annabelle Aquino		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Lack of supervision resulting in a daycare child sustaining an injury 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 this closing complaint investigation via tele-inspection. Interviews and information obtained regarding allegation. According to Licensee, on July 7 2020, there was an "accident" with a child. At approx 12:30PM, Licensee was bringing a cup of soup to a child (C1) who was waiting/sitting on the couch and the child "reached out and grabbed the cup of soup causing it to fall to the floor which in turn splashed some of the soup on child's arm/hand. Licensee stated she immediately got the child to the sink and ran cold water over the child's right arm/hand. She said she monitored and observed child the rest of the day and child appeared to be fine and didn't complain of any pain.
(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: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

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-20201125103822

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: AQUINO, ANNABELLE	FACILITY NUMBER: 414004024
	VISIT DATE: 02/25/2021

NARRATIVE

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The investigation determined there is not enough available sufficient information provided in complaint to prove allegations of inappropriate napping procedures, child left unattended during care, or and incidents regarding a child not secured during meal/snack time resulting in an injury.

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: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

LIC9099 (FAS) - (06/04)

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