384001816-11-14-2024-05-CC-AZEA-DB9QDK-20241122110448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384001816
Report Date: 11/05/2024
Date Signed: 11/14/2024 12:53:52 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
09/30/2024 and conducted by Evaluator Jonathan Tse

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20240930144644

FACILITY NAME:	PACIFIC PRIMARY - ORANGE SUN CAMPUS		FACILITY NUMBER:	384001816
ADMINISTRATOR:	STANCIL, MADONNA-DIRECTOR		FACILITY TYPE:	850
ADDRESS:	1501 GROVE STREET		TELEPHONE:	(415) 409-1961
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY:	75	CENSUS: 73	DATE:	11/05/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Director, Madonna Stancil		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

1
2
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5
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7
8
9

-Facility staff are not providing adequate supervision to day care children

INVESTIGATION FINDINGS:

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2
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5
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9
10
11
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13

On 11/14/2024, at approximately 12:15PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced complaint investigation visit to deliver findings regarding the above allegation. LPA met with Director Madonna Stancil and explained the purpose of the visit. The facility was operating within staffing and ratio requirements on this day.

During the course of the investigation, LPA conducted site observations, record review, and interviews with relevant parties. Based on relevant information reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

Appeal rights were provided and explained to D1. A notice of site visit was provided and must be posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Madonna Stancil.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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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