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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004012
Report Date: 09/22/2021
Date Signed: 09/22/2021 05:26:34 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
07/26/2021 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210726162832
FACILITY NAME:AU P'TIT MONDE, INC.FACILITY NUMBER:
384004012
ADMINISTRATOR:GOLTSER, SALIMAFACILITY TYPE:
850
ADDRESS:1100 DIVISADERO STREETTELEPHONE:
(415) 374-1876
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY:50CENSUS: 29DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Karina Cherfouni, Salima GoltserTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff did not maintain appropriate staffing ratios
Staff did not have appropriate teacher qualifications
Staff did not provide adequate supervision to child in care
Staff did not report incidents to licensing
Unsanitary towel used to wipe multiple daycare children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Andrea Medlin met with staff, and later director, for this conclusionary complaint visit. Purpose of visit explained. There are 29 children present during the visit with 4 staff and director.On prevous visit, LPA reviewed staff files. All staff had the appropriate educational requirements. There was one temporary staff (volunteer) here for a while, but this person was not left alone with children or directly provided any care and supervision to children. This person was in process of completing educational requirements needed, but has since left and no longer works here. It is unable to be determined whether there was a time when children were left unsupervised since there was no specific date/time given and no information gathered supported the allegation. Staff are not aware of any unusual incident that occured at the facility that met the criteria to report incident to licensing. Staff say there have been no serious injuries, no serious falls, etc. There is one child who has occasionaly gets slight bloody nose due to allergies. This was made aware to facility staff by the parent. LPA toured the children's bathrooms and observed paper towels on the sink for drying hands. Staff was asked if there was ever a time when facility used one towel for all children to dry hands and staff has said no, all children/staff use individual paper towels located on the sink. (continued on next page 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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-20210726162832
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AU P'TIT MONDE, INC.
FACILITY NUMBER: 384004012
VISIT DATE: 09/22/2021
NARRATIVE
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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.

This report is reviewed with director and a copy of this report must be made available for public review upon request.

Notice of site visit shall remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2