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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380506534
Report Date: 10/05/2021
Date Signed: 10/05/2021 08:46:23 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/20/2021 and conducted by Evaluator Marie Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210720162904
FACILITY NAME:SULLIVAN, PATRICIAFACILITY NUMBER:
380506534
ADMINISTRATOR:SULLIVAN, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 661-6124
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:14CENSUS: 9DATE:
10/05/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sofia LamTIME COMPLETED:
09:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Facility is not clean
- Licensee does not keep the facility free from insects
- Facility is malodorous
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced inspection to close a complaint. LPA met with Helper Sofia Lam and explained purpose of inspection. Present in home were the Licensee, two helpers, and nine children in care (one infant and eight preschool age).

During the course of the investigation, interviews and physical plant tour were conducted and pertinent documents were reviewed. Based on information gathered, there is not enough evidence to prove that the facility is not clean, Licensee does not keep the facility free from insects, and the facility is malodorous.

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 closed as UNSUBSTANTIATED.

An exit interview was conducted with Helper Sofia Lam. A copy of this report and Notice of Site Visit was provided. Notice of Site Visit to remain posted for 30 days.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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