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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384000529
Report Date: 07/17/2024
Date Signed: 07/17/2024 11:16:33 AM

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
04/26/2024 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240426144309
FACILITY NAME:FERNANDEZ, ANA M.FACILITY NUMBER:
384000529
ADMINISTRATOR:FERNANDEZ, ANA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 641-8711
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:14CENSUS: 2DATE:
07/17/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Ana FernandezTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility operated over capacity.
Staff did not provide a safe environment for children in care.
INVESTIGATION FINDINGS:
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On 7/17/2024 at 8:50AM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Ana Fernandez. The purpose of today's inspection was explained and was for an unannounced complaint investigation. Present was the licensee and assistant for 2 children. All children present were infant-age. Facility was inspected for health and safety hazards.

During inspection, LPA performed observation, interviews, and reviewed the facility records.

As part of this investigation, observations were conducted on 5/2/2024 and 7/17/2024. LPA reviewed facility's records, which included the children’s files and personnel files. LPA conducted interviews with licensee; staff; and guardians. (REFER TO 9099C FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
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 4
Control Number 05-CC-20240426144309
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: FERNANDEZ, ANA M.
FACILITY NUMBER: 384000529
VISIT DATE: 07/17/2024
NARRATIVE
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(Page 2)
Based on evidence collected; LPA was unable to determine if staff did not provide a safe environment for children in care. During inspection, LPA observed on-limit areas maintained neat, with furniture and playthings in good repair.

Based on evidence collected; LPA was unable to determine if facility operated over capacity. During inspection, LPA observed licensee operating within the capacity limitation stated on license.

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. No deficiencies were cited.

Exit interview was conducted with the Licensee, Ana Fernandez. Report was explained and Notice of Site Visit was provided.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4