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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004416
Report Date: 04/07/2023
Date Signed: 04/07/2023 11:51:34 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
03/23/2023 and conducted by Evaluator Brendon Van
COMPLAINT CONTROL NUMBER: 05-CC-20230323164204
FACILITY NAME:WAGENHALS,KATHLEENFACILITY NUMBER:
384004416
ADMINISTRATOR:WAGENHALS, KATHLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 552-3932
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:14CENSUS: 2DATE:
04/07/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kathleen WagenhalsTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee did not provide a safe environment for day-care children.
INVESTIGATION FINDINGS:
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 On April 7, 2023 at 10:30 am., Licensing Program Analysts (LPAs) Van and Leong conducted a subsequent complaint inspection visit to deliver findings of the above allegations. LPA rang the doorbells and no one answered the door. LPAs contacted the Licensee and was told she was at Safeway with the children and will be returning in 10 minutes. At approximately, 10:50 am, LPAs met with the Licensee, Kathleen Wagenhals, and explained the inspection's purpose. LPAs inspected the home for any health & safety concerns and observation of children's activities. The Licensee supervised two preschoolers by herself today.
As part of the investigation, LPA interviewed the Licensee and reviewed all pertinent documents. Based on the available information, it was found that the Licensee has failed to provide a safe and healthful environment to the children under her care. An acquaintance of the Licensee attempted to break into the home, and the ordeal was in the presence of the children in care, which threatened the children's physical or emotional health or safety. As a result, the preponderance of evidence standard has been met. Therefore, the above-listed allegation is found to be substantiated.
Continued on page 2...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
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
Control Number 05-CC-20230323164204
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: WAGENHALS,KATHLEEN
FACILITY NUMBER: 384004416
VISIT DATE: 04/07/2023
NARRATIVE
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See LIC9099D for the deficiency cited today. An exit interview was conducted; Plans of corrections were reviewed and developed with the Licensee. LPAs also informed the Licensee that an office visit is scheduled for April 13, 2023, at 11:00 pm. (During the inspection, the scheduled office meeting was provided to Ms. Wagenhals.) Appeal Rights were discussed with the Licensee. The Licensee was informed that reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file. A copy of the report, a notice of the site visit, deficiency, and appeal rights were provided to the Licensee. LPA informed the Licensee that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20230323164204
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: WAGENHALS,KATHLEEN
FACILITY NUMBER: 384004416
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/08/2023
Section Cited
CCR
102423(a)(2)
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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: (2)To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Licensee must ensure all children in care are being provided a safe and healthful environment. Licensee will provide a written plan and provide to Management during the office visit on April 13, 2023 at 11:00 am.
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This requirement is not met as evidenced by interview and record review. failed to provide a safe and healthful environment to the children under her care, this poses an immediate health and safety risk to children in care.
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During the inspection, a scheduled office meeting letter was provided to the Licensee.
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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: 04/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3