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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002434
Report Date: 12/19/2024
Date Signed: 12/19/2024 03:43:17 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
11/05/2024 and conducted by Evaluator Brendon Van
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20241105154553
FACILITY NAME:YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCHFACILITY NUMBER:
384002434
ADMINISTRATOR:ALVAREZ, KATIAFACILITY TYPE:
850
ADDRESS:1011 GARFIELD STREETTELEPHONE:
(415) 242-7135
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:32CENSUS: 25DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Joni Wu and Shirley LiTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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-Due to lack of supervision, child had an inappropriate interaction with another child.
INVESTIGATION FINDINGS:
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On December 19, 2024., Licensing Program Analyst (LPA) Van conducted an unannounced inspection to finalize this complaint and deliver the findings to the Center. LPA met with the lead teacher, Joni Wu. The purpose of the inspection was explained, and entry to the Center was granted. Upon entering the facility, LPA observed the children were napping. Five teachers supervised 25 children. The teachers-to-children ratio was met. During the inspection, the interim director, Shirley Li arrived.

As part of the investigation, LPA conducted interviews with teachers, students, the involved party, and the victim while reviewing all pertinent documents. Concerning the allegation of insufficient supervision resulting in inappropriate interaction between two children. Based on the information gathered, the teacher-to-child ratio was determined to be adequate. Furthermore, a staff member observed the incident and actively engaged, providing positive reinforcement to the children.

The Department has investigated the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are Unsubstantiated.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with the Interim Director, Shirley Li.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
11/05/2024 and conducted by Evaluator Brendon Van
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20241105154553

FACILITY NAME:YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCHFACILITY NUMBER:
384002434
ADMINISTRATOR:ALVAREZ, KATIAFACILITY TYPE:
850
ADDRESS:1011 GARFIELD STREETTELEPHONE:
(415) 242-7135
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:32CENSUS: 25DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Joni Wu and Shirley LiTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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-The facility did not appropriately address the inappropriate behavior of children with families and the Department following the incident.
INVESTIGATION FINDINGS:
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On December 19, 2024., Licensing Program Analyst (LPA) Van conducted an unannounced inspection to finalize this complaint and deliver the findings to the Center. LPA met with the lead teacher, Joni Wu. The purpose of the inspection was explained, and entry to the Center was granted. Upon entering the facility, LPA observed the children were napping. Five teachers supervised 25 children. The teachers-to-children ratio was met. During the inspection, the interim director, Shirley Li, arrived.

During the investigation, LPA conducted interviews with teachers, children, the party involved, and the victim, in addition to reviewing all relevant documentation. Concerning the allegation that the facility failed to take appropriate action in response to inappropriate behavior among children with families, it was revealed that following a particular incident, the center did not report the occurrence promptly or consistently communicated with all families affected by the incident. Consequently, the allegation was determined to be substantiated.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with the Interim Director, Shirley Li.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20241105154553
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH
FACILITY NUMBER: 384002434
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
101212(d)(1)(C)
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101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
(1) Events reported shall include the following: (C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

This requirement is not met as evidenced by:
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The center is required to formulate a comprehensive written plan or to conduct a review with all staff members regarding the reporting requirements as specified in Title 22 regulations. It is imperative that the center submit this plan or the associated training materials, along with the signatures of all staff members who participate in the training, by January 17, 2025.
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Based on the interview and record review, the center is not in compliance with the above regulation; the center did not properly report an incident that occurred in a timely manner. This violation potentially poses a health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3