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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004535
Report Date: 05/23/2019
Date Signed: 05/23/2019 05:14:43 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
05/17/2019 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20190517113144
FACILITY NAME:GARCIA, MARIA ISABELFACILITY NUMBER:
414004535
ADMINISTRATOR:GARCIA, MARIA ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 873-4204
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:14CENSUS: 13DATE:
05/23/2019
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Maria Garcia, Sonia DubonTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
FCCH operates out of ratio

INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Andrea Medlin met with Licensee for this complaint visit. Purpose of visit explained. There were 13 children (2 infants, 10 preschool, and 1 school aged) initially present with just Licensee. During the visit, two children were picked up and a staff helper arrived. At the time of arrival to daycare, the daycare was operating out of ratio due to only Licensee being present. Licensee states she did not have a helper upon arrival due to some unforseen circumstances.

Based on LPAs observation the preponderance of evidence standard has been met, therefore the above listed allegation is found to be substantiated.

The deficiencies cited on the following page are in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1. This report is reviewed with Licensee 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.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
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 3
Control Number 05-CC-20190517113144
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: GARCIA, MARIA ISABEL
FACILITY NUMBER: 414004535
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2019
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.
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Licensee reminded of requirements for ratio and capacity and to operate at a large daycare ratio, a helper must always be present.

Deficiency cleared during visit; helper arrived.
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This requirement is not met as observed Licensee caring for 13 children without helper upon arrival. This is an immediate health and safety risk.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
05/17/2019 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20190517113144

FACILITY NAME:GARCIA, MARIA ISABELFACILITY NUMBER:
414004535
ADMINISTRATOR:GARCIA, MARIA ISABELFACILITY TYPE:
810
ADDRESS:305 ROCKWOOD DRIVETELEPHONE:
(650) 873-4204
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:14CENSUS: 13DATE:
05/23/2019
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Maria Garcia, Sonia DubonTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Children are allowed access to off limit areas in FCCH.
Caregiver used an inappropriate form of discipline.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Andrea Medlin met with Licensee, and later helper, for this complaint visit. Interviews conducted with Licensee and children in regard to discipline policy and areas of the daycare being used. Due to inconsistent given statements, it cannot be proven or disproven regarding any violations of children's personal rights or off limits areas being used.

Although the 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 the allegations are unsubstantiated.

This report is reviewed with Licensee and a copy of this report must be made available for public review upon request.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3