<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004141
Report Date: 10/03/2024
Date Signed: 10/03/2024 11:48:14 AM

Substantiated


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
09/26/2024 and conducted by Evaluator Jennifer Yee
COMPLAINT CONTROL NUMBER: 05-CC-20240926145254
FACILITY NAME:CHAMORRO, CLAUDIA M.FACILITY NUMBER:
384004141
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 5DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Claudia M. ChamorroTIME COMPLETED:
12:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Adult lives/access to the home has no fingerprint clearance

An adult who has access to the home smokes cigarettes and pot
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts, LPAs Yee and Gil conducted a visit to open this complaint. The purpose of the visit was complaint. Present at the facility are the licensee, Claudia, one helper, and 5 children. LPAs inspected the facility, interviewed the licensee, and obtained the roster.

The licensee, Claudia admits that the individual does come to the home at night 1-2 times a week. On the weekends, he comes to the house during the day. The individual lives in the lower level's room and the room is locked. Claudia said she does not have the key to the room. The individual has been living there for 6 months to a year. In addition, based on the inspection/observation of the lower level, there is a smoke smell. Therefore, the preponderance of evidence standard has been met, the above allegation(s) is found to be substantiated. California Code of Regulations, (Title 22, Div 12 Chp3), is being cited on the attached LIC9099d. See next page for Type A citation.

The facility was advised to post and provide copies of this report to parents and guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents shall sign the LIC 9224 as proof of receipt. Appeal Rights was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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 2
Control Number 05-CC-20240926145254
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: CHAMORRO, CLAUDIA M.
FACILITY NUMBER: 384004141
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/10/2024
Section Cited
CCR
102370(d)
1
2
3
4
5
6
7
102370 Criminal Record Clearance(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
1
2
3
4
5
6
7
The licensee shall submit a written Plan of Correction (POC) describing how to ensure all staff/residents have Criminal Record Clearance prior to working or living at the facility, by the due date, 10/10/2024.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on the record review the individual does not have Criminal Record Clearance. The licensee failed to ensure staff has criminal record clearance prior to living in the facility, which poses an immediate health and safety risk to children in care. Civil Penalties of $500 was accessed.
8
9
10
11
12
13
14
Type A
10/10/2024
Section Cited
CCR
102423
1
2
3
4
5
6
7
102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (1) To be treated with dignity in his/her personal relationship with staff and other persons.
1
2
3
4
5
6
7
The licensee shall submit a written Plan of Correction (POC) by due date, 10/10/2024.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on the interview/inspection, there is a smoke smell. The licensee failed to ensure staff has criminal record clearance prior to living in the facility, which poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14
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: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2