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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380504984
Report Date: 12/04/2023
Date Signed: 12/04/2023 02:58:36 PM

Unsubstantiated


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
09/11/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230911115854
FACILITY NAME:KATHERINE MICHIELS SCHOOLFACILITY NUMBER:
380504984
ADMINISTRATOR:ANCHETA, YOLANDAFACILITY TYPE:
830
ADDRESS:1335 GUERRERO STREETTELEPHONE:
(415) 821-0130
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:15CENSUS: 12DATE:
12/04/2023
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Maria LunaTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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9
Staff are not addressing hazardous objects that pose a threat to day care children in care.
Facility is out of ratio.
INVESTIGATION FINDINGS:
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On 12/4/2023 at 11:45AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Administrator, Maria Luna. Purpose of the inspection was explained and was for an Unannounced, Complaint Investigation. Present was the Administrator and 4 staff supervising 12 children. Children present had been signed in. LPA inspected facility indoors and outdoors for health and safety hazards.

During today's inspection, LPA performed site observations, interviews, and reviewed facility records. LPA reminded administrator to ensure staff’s proof of immunization are stored in facility files. Advisory Note: Technical Violation (LIC9102TV) was issued.

During the course of the investigation observations were conducted on 9/18/2023 and 12/4/2023. A review of the facility records was complete, which included the Staff Records, Children Records, Incident Reports, and Parent Handbook. LPA conducted interviews with Director, Administrator, and Staff. (REFER TO LIC9099C, FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
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 2
Control Number 05-CC-20230911115854
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: KATHERINE MICHIELS SCHOOL
FACILITY NUMBER: 380504984
VISIT DATE: 12/04/2023
NARRATIVE
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(Page 2)
Regarding allegation of staff are not addressing hazardous objects that pose a threat to day care children in care; Based on information collected, LPA was unable to determine if the allegation made is valid.

Regarding allegation of facility is out of ratio; Based on information collected, LPA was unable to determine if allegation made is valid. During inspection, LPA observed facility operating within the required Staff-Child Ratio.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.



Exit interview was conducted with Administrator, Maria Luna. Complaint Report was explained and Appeal Rights were given. Notice of Site Visit was posted during inspection.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2