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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004684
Report Date: 05/17/2024
Date Signed: 05/17/2024 11:00:41 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
02/29/2024 and conducted by Evaluator Winnie Ly
COMPLAINT CONTROL NUMBER: 05-CC-20240229155614
FACILITY NAME:COW HOLLOW SCHOOLFACILITY NUMBER:
384004684
ADMINISTRATOR:CAMPBELL, DARCYFACILITY TYPE:
850
ADDRESS:387 MORAGA AVENUETELEPHONE:
(415) 921-2328
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94129
CAPACITY:150CENSUS: 115DATE:
05/17/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Darcy CampbellTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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1. Staff did not prevent child in care from causing injuries to another child in care-Day Care Child was bitten on more than one occasion.
2. Facility Staff Isolate Day Care Child.
INVESTIGATION FINDINGS:
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On May 16, 2024, Licensing Program Analysts (LPAs) Ly and Basak, arrived at the facility unannounced to conduct a conclusionary complaint visit into the above allegations. LPAs met with Executive Director, Darcy Campbell. Purpose of visit was explained. Present during today’s visit were 25 staff including the Executive Director caring for 115 children.

Based on information obtained during the course of this investigation through interviews, record review and evidence of pictures, it is determined that allegations Staff did not prevent child in care from causing injuries to another child in care-Day Care Child was bitten on more than one occasion & Facility staff isolate day care child; the preponderance of evidence standards has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, Type B deficiencies is being cited on the attached LIC9099D.

A copy of this report and appeal rights were discussed and left with Executive Director whose signature on this form confirm receipt of the report. Notice of Site Visit was provided. Notice to remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
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-20240229155614
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: COW HOLLOW SCHOOL
FACILITY NUMBER: 384004684
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
101223(a)(2)
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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations. This requirement is not met evidence by:
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A health and safety action plan/policy must be implemented to provide adequate care and supervision for all children in the classroom. Policy must be enforced to protect the general welfare of all children in the classroom/facility.
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Based on interviews and record review, child was bitten by another child 4 times within 6 months. This poses a potential health and safety risks to children in care.
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A plan is to be submitted to Licensing by 05/31/2024.
Type B
05/31/2024
Section Cited
CCR
101223(a)(1)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met evidence by:
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Facility will implement a plan so that every child will be included into the activities.
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Based on interview of staff, child was kept in the classroom with the teachers, the rest of the group, went to the Studio Room to do art project. This poses a potential health and safety risk to children in care.
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Plan will be submitted to Licensing by 05/31/2024.
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: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2