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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414001399
Report Date: 06/30/2023
Date Signed: 06/30/2023 01:39:19 PM

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
05/05/2023 and conducted by Evaluator Leslit Tapia-Mandujano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230505134753
FACILITY NAME:RCSD-ADELANTE-SELBY SPANISH IMMERSION CDCFACILITY NUMBER:
414001399
ADMINISTRATOR:ORTIZ, AIDAFACILITY TYPE:
850
ADDRESS:170 SELBY LANETELEPHONE:
(650) 482-5957
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY:50CENSUS: 15DATE:
06/30/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Site Supervisor, Aida Ortiz de AguilarTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is unsanitary
Facility does not have appropriate accommodations for children's needs
INVESTIGATION FINDINGS:
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On June 30th at approximately 11:40am, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, complaint investigation and met with Site Supervisor, Aida Ortiz de Aguilar regarding the above allegations and explained the purpose of the visit. LPA and Site Supervisor toured the facility for health and safety hazards. Facility is currently operating only Room #1, and Room #2 is closed for the Summer.

Complaint was received by the Department on 05/05/23. Present in the facility are Site Supervisor and 4 teachers caring for 15 preschool age children. All adults working or living in the facility have fingerprint clearance and are associated through the School District.

During the course of the investigation, interviews were conducted with parents and staff, and relevant documents were gathered. During the course of the investigation, LPA detrmined by interviews and observations that the facility did not have the appropriate accommodations for the children that were enroled and attending. Facility is enrolling the children prior to providing the proper accommodations for the enrolled children's need. Due to there not being proper accommodations, it led to the staff praciticing unsanitary procedures for children in care.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023
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-20230505134753
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: RCSD-ADELANTE-SELBY SPANISH IMMERSION CDC
FACILITY NUMBER: 414001399
VISIT DATE: 06/30/2023
NARRATIVE
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Based on interviews, observations, and record review which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, are being cited. Please refer to 9099D for more information.

Upon receipt of this report, Licensee shall post the Notice of Site Visit. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.

After today’s visit, an exit interview was conducted, report was reviewed and copy was provided to Site Supervisor, Aida Ortiz de Aguilar.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20230505134753
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: RCSD-ADELANTE-SELBY SPANISH IMMERSION CDC
FACILITY NUMBER: 414001399
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2023
Section Cited
CCR
101223(a)(2)
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101223(a)(2): Peronal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights;(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Facility must have a plan in pace in what accommodations are needed for the children that will be enrolled.

Plan will be submitted to LPA Tapia-Mandujano by July 31st, 2023.

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Based on interviews, observations, and record review, the facility did not comply with the section cited above as staff did not have the appropriate accommodations to meet the needs of children, causing there to be unsanitary practices, which poses a potential health, safety or personal rights risk to persons in care.
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Prior to the children first day, the furnishings and equipment must be set up, to meet the child's need to have safe, healthful, and comfortable acommodations.
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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: Ali Zebila
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023
LIC9099 (FAS) - (06/04)
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