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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005477
Report Date: 09/03/2025
Date Signed: 11/05/2025 11:01:26 AM

Substantiated


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
08/29/2025 and conducted by Evaluator Nicole Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20250829094447
FACILITY NAME:HUMMINGBIRDS COLLABORATIVE SCHOOLFACILITY NUMBER:
214005477
ADMINISTRATOR:RICHARD, MELINDAFACILITY TYPE:
850
ADDRESS:1990 NOVATO BLVD.TELEPHONE:
(415) 760-6197
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:42CENSUS: 30DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Assistant Director, April JacksonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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-Staff did not ensure supervision was provided to child in care resulting in child elopement
INVESTIGATION FINDINGS:
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***This is an amended report to change the report status.***

On September 3, 2025, Licensing Program Analysts (LPAs) Tran and Van conducted an unannounced inspection to investigate a complaint the Department received on August 29, 2025. LPAs met with lead teacher, Olimpia Moreno. The Director, Melinda Richard, was currently out of the office. The purpose of the inspection was explained, and entry to the center was granted. Five teachers and two paraprofessionals supervised 30 preschool children. The teacher-to-children ratio was maintained. The Assistant Director, April Jackson, arrived during the inspection.

As part of the investigation, interviews were conducted, and all pertinent documents were collected and reviewed. Based on the available information, the center self-reported an incident in which a child allegedly sneaked out through the porch gate to leave the facility unnoticed and was subsequently located by another parent in the center's parking lot. The exact duration for which the child was left unsupervised remains unclear.

Continued on Page Two
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Nicole Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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 4
Control Number 05-CC-20250829094447
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: HUMMINGBIRDS COLLABORATIVE SCHOOL
FACILITY NUMBER: 214005477
VISIT DATE: 09/03/2025
NARRATIVE
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Page Two

Based on the totality of information obtained, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A $500 civil penalty was assessed today.

See LIC 9099D for a Type A deficiency cited today.

LPA Tran informed the Assistant Director, April Jackson, that this report, dated September 3, 2025, documents a Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Tran informed the Assistant Director to provide a copy of this licensing report dated September 3, 2025, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

An exit inspection was conducted with the Assistant Director, April Jackson, while the Director, Melinda Richard, was on speakerphone. The report and appeal rights were provided to the Assistant Director.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Nicole Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 05-CC-20250829094447
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: HUMMINGBIRDS COLLABORATIVE SCHOOL
FACILITY NUMBER: 214005477
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2025
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision

(a)The licensee shall provide care and supervision...children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).

This requirement is not met, as evidenced by:
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The center will implement mandatory staff training, or a refresher course, focused on supervision. The agenda will cover topics such as supervision practices, relevant policies and procedures, and various supervision scenarios for staff engagement. All training materials, along with documentation of staff training attendance, must be submitted by September 4, 2025.
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Based on staff interviews and facility incident reports. The center did not comply with the above regulation. C1 sneaked out from the center front gate without the teacher's knowledge and was subsequently located by another parent in the parking lot. This poses an immediate 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: Ali Zebila
LICENSING EVALUATOR NAME: Nicole Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4