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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005379
Report Date: 08/21/2025
Date Signed: 08/21/2025 03:25:12 PM

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
05/22/2025 and conducted by Evaluator Nathan Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20250522131338
FACILITY NAME:ANDREWSCAMPSFACILITY NUMBER:
214005379
ADMINISTRATOR:LEWIS, OLIVIAFACILITY TYPE:
840
ADDRESS:400 TAMAL PLAZA #401ATELEPHONE:
(415) 446-8946
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:96CENSUS: 14DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Kelsey RodererTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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9
Staff does not ensure playground equipment is properly maintained for children's safety.
Staff does not ensure facility is kept in clean sanitary conditions.
INVESTIGATION FINDINGS:
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5
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On August 21, 2025, Licensing Program Analyst (LPA) Garcia conducted a complaint inspection in response to the above complaint allegations. LPA met with summer Director, Kelsey Roderer and explained purpose of inspection. There were 7 children and 5 staff members present in the facility during the inspection. 7 additional children arrived during the inspection. LPA reminded director of school-age children ratios and supervision.

During the course of the investigation, observations and relevant documents were gathered. Based on all pertinent information, the preponderance of evidence standard has been met, therefore the above allegation(s) are found Substantiated.

See deficiencies issued during today's visit.

LPA conducted exit interview with Summer Director, Kelsey Roderer.
Report and Notice of Site Visit was provided. Notice of Site Visit will be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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-20250522131338
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: ANDREWSCAMPS
FACILITY NUMBER: 214005379
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
CCR
101238(a)
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101238(a) Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidence by:
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The facility will shampoo the carpet and replace/repair the wooden floorings that are moving.
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Based on LPA observations, the facility's carpet and bean bags have visible stains. The wooden floor on the second floor is also observed to be moving around.
Which poses a potential health, safety, or personal rights risk to persons in care.
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Facility will send proof of corrections by set due date.
Type B
09/19/2025
Section Cited
CCR
101239(n)
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101239 Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidence by:
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The facility plans to organize all toys in the facility and throw away broken toys to prevent children from using them.
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Based on observations, there are facility toys that are broken and seats that have holes. There are also blue mats that are torn with visible foam.
Which poses a potential health, safety, or personal rights risk to persons in care.
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9
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Facility will send proof of corrections by set due date.
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: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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
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
05/22/2025 and conducted by Evaluator Nathan Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20250522131338

FACILITY NAME:ANDREWSCAMPSFACILITY NUMBER:
214005379
ADMINISTRATOR:LEWIS, OLIVIAFACILITY TYPE:
840
ADDRESS:400 TAMAL PLAZA #401ATELEPHONE:
(415) 446-8946
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:96CENSUS: 14DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Kelsey RodererTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating out of ratio.
Staff allows children to be left unsupervised.
Licensee does not ensure staff are in good health to while providing care to children.
INVESTIGATION FINDINGS:
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3
4
5
6
7
8
9
10
11
12
13
On August 21, 2025, Licensing Program Analyst (LPA) Garcia conducted a complaint inspection in response to the above complaint allegations. LPA met with summer Director, Kelsey Roderer and explained purpose of inspection. There were 7 children and 5 staff members present in the facility during the inspection. 7 additional children arrived during the inspection. LPA reminded director of school-age children ratios and supervision.

During the course of the investigation, interviews were conducted and relevant documents were gathered. Based on the observations, interviews and relevant documents, there was no sufficient evidence to prove the above allegations. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated.

LPA conducted exit interview with Summer Director, Kelsey Roderer.
Report and Notice of Site Visit was provided. Notice of Site Visit will be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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