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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415326
Report Date: 11/04/2021
Date Signed: 11/04/2021 04:24:45 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/22/2021 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210922105317
FACILITY NAME:STANFORD ARBORETUM CHILDREN'S CENTERFACILITY NUMBER:
434415326
ADMINISTRATOR:MARY ALLISON MONROEFACILITY TYPE:
830
ADDRESS:215 QUARRY ROADTELEPHONE:
(650) 725-6328
CITY:STANFORDSTATE: CAZIP CODE:
94305
CAPACITY:40CENSUS: 23DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Marsha DrewTIME COMPLETED:
04:41 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Day care child sustained multiple severe injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Melanie Otsuji met with Assistant Director, Marsha Drew, to deliver the findings of a complaint investigation regarding the above allegation. Present during the inspection were 11 staff members and 23 infant aged children.

The investigation was conducted by Supervising Special Investigator (SSI), Megan Mullen of the Bureau of Investigations. During the investigation, interviews were conducted. Based on interviews conducted, the allegation may have happened or is valid, however there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/22/2021 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210922105317

FACILITY NAME:STANFORD ARBORETUM CHILDREN'S CENTERFACILITY NUMBER:
434415326
ADMINISTRATOR:MARY ALLISON MONROEFACILITY TYPE:
830
ADDRESS:215 QUARRY ROADTELEPHONE:
(650) 725-6328
CITY:STANFORDSTATE: CAZIP CODE:
94305
CAPACITY:40CENSUS: 23DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Marsha DrewTIME COMPLETED:
04:41 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff did not notify day care child's authorized representtative of incident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Melanie Otsuji met with Assistant Director, Marsha Drew, to deliver the findings of a complaint investigation regarding the above allegation. Present during the inspection were 11 staff members and 23 infant aged children.

The investigation was conducted by Supervising Special Investigator (SSI), Megan Mullen of the Bureau of Investigations. During the investigation, interviews were conducted. Based on interviews conducted, the allegation may have happened or is valid, however there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2