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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 210110015
Report Date: 03/08/2023
Date Signed: 03/08/2023 11:37:45 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
03/08/2022 and conducted by Evaluator Hanson Leong
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220308112643
FACILITY NAME:FAIRFAX SAN ANSELMO CHILDREN'S CENTERFACILITY NUMBER:
210110015
ADMINISTRATOR:TOMSKY, HEIDIFACILITY TYPE:
850
ADDRESS:199 PORTEOUS AVENUETELEPHONE:
(415) 454-1811
CITY:FAIRFAXSTATE: CAZIP CODE:
94930
CAPACITY:35CENSUS: 15DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Heidi TomskyTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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- Staff inappropriately touched child in care
INVESTIGATION FINDINGS:
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***Duplicate Report ***
On 3/8/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced conclusionary complaint visit to the Fairfax San Anselmo Children's Center. The LPA was granted entry by the Director. Heidi Tomsky. The LPA explained the purpose of the visit to the director. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed four staff members supervising fifteen preschool age children. Children's capacity and ratio requirements were observed to be in compliance

The above allegation was investigated by our Investigative Branch (IB). Based on information obtained from the IB investigation, the preponderance of evidence standard has been met, therefore the above allegation, staff inappropriately touched child in care, is found to be substantiated.

***The particular individual's employment with the facility was terminated in 2017 as a direct result of the allegation.*** ***See Page 2 for continuation***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
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-20220308112643
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FAIRFAX SAN ANSELMO CHILDREN'S CENTER
FACILITY NUMBER: 210110015
VISIT DATE: 03/08/2023
NARRATIVE
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Continued, Page 2
A copy of this report, the “Notice of Site Visit,” and their appeal rights were given to the director.

The "Notice of Site Visit” shall be posted for 30 days.

Failure to maintain postings as required, will result in an immediate $100 civil penalty.

Exit interview conducted and report was reviewed with the Director, Heidi Tomsky

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20220308112643
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: FAIRFAX SAN ANSELMO CHILDREN'S CENTER
FACILITY NUMBER: 210110015
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/08/2023
Section Cited
CCR
101223(a)(3)
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(a) The licensee shall ensure that each child is accorded the following personal rights: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion,
This requirement is not met as evidenced by:
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The indivdual who inappropriately touched child in care was terminated in 2017
No further action is required,
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Based on Investigative Branch's investigation, the allegation, staff inappropriately touched child in care. was substantiated, which poses a potential health and safety risk to children in care.
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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.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3