<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004197
Report Date: 08/05/2024
Date Signed: 08/16/2024 03:36:36 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 always present during operation hours.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
ADDENDUM TO ORIGINAL LIC 9099 FINDING dated on 08/05/2024

LPA Medrano completed an unannounced complaint visit for the purpose of delivering an AMENDED finding related to the above allegation. Due to new information that has been received, finding is now changed from SUBSTANTIATED to UNSUBSTANTIATED.

LPA Medrano interviewed staff and parents. Based on interviews, observations, as well as information gathered; The allegation 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. Signatures are on file for licensees.



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)
Page: 1 of 2
Control Number 05-CC-20240520090744
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HARVILLE, ANA M.& REUSCHE LARI, M
FACILITY NUMBER: 414004197
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
CCR
1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14

8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2