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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004525
Report Date: 08/14/2023
Date Signed: 08/14/2023 02:07:58 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
05/19/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230519091750
FACILITY NAME:SWEET PEAS TOOFACILITY NUMBER:
384004525
ADMINISTRATOR:DIONNE, SAMANTHAFACILITY TYPE:
830
ADDRESS:2730 17TH STREETTELEPHONE:
(415) 701-0495
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:32CENSUS: 25DATE:
08/14/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Annette MedranoTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not properly label food.
Infants left without proper supervision.
INVESTIGATION FINDINGS:
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On 8/14/2023 at 9:00AM., Licensing Program Analyst (LPA) Luis Gomez met with Assistant Director, Annette Medrano. Purpose of the inspection was explained and was for an Unannounced, Complaint Investigation. Present was the Assistant Director and 6 staff caring for 25 children. LPA inspected facility for health and safety hazards.

During inspection, LPA performed site observations, interviews and reviewed facility records.

During the course of this investigation, observations were conducted on 5/26/2023, 7/7/2023, and 8/14/2023. A review of the facility records was complete, which included the staff records, children’s roster, and parent handbook. LPA conducted interviews with Staff, Assistant Director, Licensee/ Director and Involved Parties. (REFER TO LIC9099C, FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
05/19/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230519091750

FACILITY NAME:SWEET PEAS TOOFACILITY NUMBER:
384004525
ADMINISTRATOR:DIONNE, SAMANTHAFACILITY TYPE:
830
ADDRESS:2730 17TH STREETTELEPHONE:
(415) 701-0495
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:32CENSUS: 25DATE:
08/14/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Anette MedranoTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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2
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8
9
Staff do not ensure that facility is free from rodents.
Staff restrict infant's movement.
INVESTIGATION FINDINGS:
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13
On 8/14/2023 at 9:00AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Assistant Director, Annette Medrano. Purpose of the inspection was explained and was for an Unannounced, Complaint Investigation. Present was the Assistant Director and 6 staff caring for 25 children. LPA inspected facility for health and safety hazards.

During inspection, LPA performed site observations, interviews and reviewed facility records.

During the course of this investigation, observations were conducted on 5/26/2023, 7/7/2023, and 8/14/2023. A review of the facility records was complete, which included the staff records, children’s roster, and parent handbook. LPA conducted interviews with Staff, Assistant Director, Licensee/ Director and Involved Parties. (REFER TO LIC9099C, FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 05-CC-20230519091750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SWEET PEAS TOO
FACILITY NUMBER: 384004525
VISIT DATE: 08/14/2023
NARRATIVE
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(Page 2)
Based on evidence collected, LPA is unable to determine if staff do not ensure facility is free of rodents. During interview, director stated several months prior, a rodent/ mouse was observed by staff. Per director, pest control service was immediately notified, and facility was professionally services.

Based on evidence collected, LPA was unable to determine if staff restrict infant’s movement. Per assistant director, facility follow safe sleep protocol, for napping infants at all times.

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 allegation is Unsubstantiated.

LPA conducted exit interview with Assistant Director, Anette Madrano. Complaint report explained and the Notice of Site Visit was posted during inspection.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 05-CC-20230519091750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SWEET PEAS TOO
FACILITY NUMBER: 384004525
VISIT DATE: 08/14/2023
NARRATIVE
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(Page 2)
Regarding the allegation of staff do not properly label food; Based on interview and observations; LPA determined allegation made is valid.

Regarding the allegation of infants left without proper supervision; Based on interview, observation, and record review, LPA determine allegation made is valid.

Therefore, the preponderance of evidence standard has been met, with allegations found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) are being cited on attached 9099D.

Notice of site visit was provided to Assistant Director, Anette Medrano. Website for Forms and Regulations: www.ccld.ca.gov. Appeal rights were provided.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 05-CC-20230519091750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SWEET PEAS TOO
FACILITY NUMBER: 384004525
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2023
Section Cited
CCR
102427(j)
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102427(j) Infant Care and Food Services. (j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date. This requirement is not met as evidenced by:
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Licensee will ensure all children bottles are properly labeled with child's name and date. Written protocol for staff review will be added to in-take procedure by due: Date: 08/18/2023.
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At 9:45AM., Based on observations, LPA confirmed infant bottles are not properly labeled with infant's name or current date. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to department via email.
Type B
08/18/2023
Section Cited
CCR
101416.5(b)
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101416.5(b) Staff- Infant Ratio. (b) There shall be a ratio of one teacher for every four infants in attendance. This requirement was not met as evidenced by:
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Licensee will ensure staff ratio of 1:4 Infant- Staff ratio is followed at all times. Written staff schedule will be submitted by the due date: 8/18/2023.
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At 9:25AM., Based on observations, LPA confirmed facility is operating out of required ratio, in infant classroom with three staff supervising 13 children. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the department via email.
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: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7