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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004197
Report Date: 08/05/2024
Date Signed: 08/05/2024 02:46:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
05/20/2024 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240520090744
FACILITY NAME:HARVILLE, ANA M.& REUSCHE LARI, MFACILITY NUMBER:
414004197
ADMINISTRATOR:HARVILLE, ANA & REUSCHE LAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 537-7469
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY:14CENSUS: 6DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ana & MariaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee's are not providing adequate care and supervision of the daycare children.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kassandra Medrano, conducted an unannounced inspection in order to deliver findings on the complaint investigation for the above allegation. LPA Medrano met with the licensees, ana and maria to discuss complaint allegations findings.Present in the home are the two licensees and 6 children.

Based on LPAs observations, record reviews, and interviews which were conducted. The allegation above 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.

Exit interview conducted and a copy of this report and appeal rights were reviewed and provided to Licensees, Ana and Maria.

Notice of Site visit was observed to be posted and shall remain posted for 30 days.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
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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