384002982-11-5-2021-05-CC-GLEG-C8Q4LC-20211112181141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002982
Report Date: 11/05/2021
Date Signed: 11/05/2021 12:40:12 PM

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
09/08/2021 and conducted by Evaluator Sheran Lo

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210908134723

FACILITY NAME:	FRANDELJA FAIRFAX		FACILITY NUMBER:	384002982
ADMINISTRATOR:	COBBINS, CORNELL		FACILITY TYPE:	850
ADDRESS:	901 B FAIRFAX AVENUE		TELEPHONE:	(415) 822-1699
CITY:	SF	STATE: CA	ZIP CODE:	94124
CAPACITY:	56	CENSUS: 15	DATE:	11/05/2021
		UNANNOUNCED	TIME BEGAN:	10:37 AM
MET WITH:	Cornell Cobbins		TIME COMPLETED:	12:08 PM

ALLEGATION(S):

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-Daycare child has an unexplained injury
-Staff did not notify authorized representative of child's injury
-Staff did not provide adequate supervision

INVESTIGATION FINDINGS:

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On November 5, 2021, Licensing Program Analyst (LPA) Sheran Lo conducted a subsequent complaint inspection and met with Site Supervisor Cornell Cobbins to discuss the above allegation. Purpose of the inspection was explained. Present is Director, 5 staff with 15 children.

During the course of the investigation, interviews were conducted with Site Supervisor, parents, and relevant documents were gathered. Based on the interviews and relevant documents, there was no sufficient evidence to prove the facility child had unexplained injury. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated.

LPA conducted exit interview with Site Supervisor. Report and Notice of Site Visit will be emailed to ccobbins@frandelja.org by the end of business day. Notice of Site Visit shall be posted for 30 consecutive days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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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