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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 11:03:13 AM

Unsubstantiated


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):
1
2
3
4
5
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7
8
9
1. Facility Staff fail to provide first aid to injured child and fail to notify parent regarding incident/injury.
2. Facility fail to adhere to school's health & safety policy.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 and record review, it is determined that allegations Facility Staff fail to provide first aid to injured child and fail to notify parent regarding incident/injury & Facility fail to adhere to school's health & safety policy. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore the allegation is UNSUBSTANTIATED. 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.
Unsubstantiated
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)
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