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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005614
Report Date: 07/31/2024
Date Signed: 08/28/2024 12:56:44 PM

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
06/03/2024 and conducted by Evaluator Jonathan Tse
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240603113007
FACILITY NAME:DUARTE, MARIANA P.FACILITY NUMBER:
214005614
ADMINISTRATOR:DUARTE, MARIANA P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 225-5982
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY:14CENSUS: 12DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Licensee, Mariana DuarteTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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-Licensee did not follow reporting requirements
INVESTIGATION FINDINGS:
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On 7/31/2024, at approximately 1:20PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced complaint investigation visit at the facility. LPA met with Licensee, Mariana Duarte, and explained the purpose of the visit. Present during the visit was Licensee, three helpers, eight preschool age children, and four infants.

During the course of the investigation, LPA conducted site observations, record review, and interviews with relevant parties. During complaint investigation visit on 6/4/2024, LPA observed that there was construction ongoing on the facility's front patio. Based on record review, LPA confirmed that the facility did not notify the Department of the construction. Based on interviews with relevant parties, Licensee stated that they did not know of the requirement to notify the Department of alterations to a Family Child Care Home or grounds.


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

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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 5
Control Number 05-CC-20240603113007
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: DUARTE, MARIANA P.
FACILITY NUMBER: 214005614
VISIT DATE: 07/31/2024
NARRATIVE
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Page Two
Based on site observations, record review, and interview, the preponderance of evidence standard has been met, therefore the above allegation that "Licensee did not follow reporting requirements" is found to be SUBSTANTIATED.

See LIC9099-D for deficiency cited today regarding reporting requirements for alterations to existing buildings or grounds. Appeal rights were provided to Licensee. A notice of site visit was provided and must be posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Mariana Duarte.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 05-CC-20240603113007
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: DUARTE, MARIANA P.
FACILITY NUMBER: 214005614
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/07/2024
Section Cited
CCR
102416.3(a)
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Alteration to Existing Buildings or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
This requirement was not met as evidenced by:
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Licensee stated that they are now aware of the requirement and will be notifying the Department of any future construction at the facility. LPA discussed the requirement with Licensee during the visit.
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The Licensee did not comply with the above by not notifying the Department of construction occurring at the facility, which posed a potential health, safety, or personal rights risk to persons in care.
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Licensee shall provide the Department with a signed statement acknowledging and understanding the requirement to report any alterations or additions to a family child care home by set due date of 8/7/2024.
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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: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5