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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384000805
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:14:59 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
08/02/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230802093326
FACILITY NAME:FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THEFACILITY NUMBER:
384000805
ADMINISTRATOR:BECERRA, PATRICIAFACILITY TYPE:
850
ADDRESS:3101 MISSION STREETTELEPHONE:
(415) 550-4178
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:16CENSUS: 13DATE:
10/03/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Patricia BacerraTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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9
Staff caused an unexplained injury to day care child.
INVESTIGATION FINDINGS:
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On 10/3/2023 at 1:00PM., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Patricia Bacerra. Purpose of the inspection was explained and was for an Unannounced, Complaint Investigation. Present was the Director and 3 staff supervising for 13 children. LPA inspected facility, indoor and outdoors, for health and safety hazards.

During today's inspection, LPA performed site observations, interviews, and reviewed facility records.

During the course of this investigation, observations were conducted 7/31/2023 and 10/3/2023. A review of the facility records was complete, which included the Staff Records;Children Records; and Parent Handbook. LPA conducted interviews Director, Staff, Children and Involved Parties. (REFER TO LIC9099C, FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
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-20230802093326
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: FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE
FACILITY NUMBER: 384000805
VISIT DATE: 10/03/2023
NARRATIVE
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(Page 2)
Regarding allegation of staff caused an unexplained injury to day care child; Based on evidence collected, LPA was unable to determine if allegation made is valid. During inspection, LPA observed classroom staff using appropriate intervention when assisting day-care children.

Although the allegation 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 allegation is Unsubstantiated.



LPA conducted exit interview with Director, Patricia Bacerra. Complaint report was explained, and the Notice of Site Visit was given during inspection.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2