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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414001561
Report Date: 01/10/2024
Date Signed: 01/10/2024 04:13:13 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
10/16/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20231016142333
FACILITY NAME:HIGHLANDS RECREATION DISTRICTFACILITY NUMBER:
414001561
ADMINISTRATOR:LEIN, KRISTENFACILITY TYPE:
850
ADDRESS:1851 LEXINGTON AVENUETELEPHONE:
(650) 341-4251
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:38CENSUS: 17DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Stacey AhlfTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff left day care children unattended.
INVESTIGATION FINDINGS:
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On 1/10/2024 at 1:10PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Interim Director, Stacey Ahlf. Purpose of inspection was explained and was for an unannounced compliant inspection. Present in facility were 4 staff supervising 17 children. Children present had been signed in. LPA inspected facility for health and safety hazards.

During inspection, LPA reviewed facility records, interviewed staff and performed site observations. At 3:30PM., Based on record review, LPA confirmed staff's proof of required immunization were missing facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

During the course of this investigation, observations were conducted by LPA on 10/24/2023 and 1/10/2024. A review of facility records was complete which included the Children’s File, Staff Files, and Program Handbook. Interviews were conducted with Staff, and Parents. (REFER TO LIC9099c, FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 5
Control Number 05-CC-20231016142333
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: HIGHLANDS RECREATION DISTRICT
FACILITY NUMBER: 414001561
VISIT DATE: 01/10/2024
NARRATIVE
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(Page 2)
Regarding the allegation of staff left day care children unattended; Based on evidence collected, LPA determine allegation made is valid.

Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) is being cited on attached 9099D.

The exit interview was conducted with Interim Director, Stacey Ahlf. The complaint investigation report was and appeal rights were explained and copy was provided.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov.

The notice of site visit was provided to facility.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
10/16/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20231016142333

FACILITY NAME:HIGHLANDS RECREATION DISTRICTFACILITY NUMBER:
414001561
ADMINISTRATOR:LEIN, KRISTENFACILITY TYPE:
850
ADDRESS:1851 LEXINGTON AVENUETELEPHONE:
(650) 341-4251
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:38CENSUS: 17DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Stacey AhlfTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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9
Staff did not prevent day care child from having access to hazardous item.
Staff did not provide adequate food service to day care children.
INVESTIGATION FINDINGS:
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On 1/10/2024 at 1:10PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Interim Director, Stacey Ahlf. Purpose of inspection was explained and was for an unannounced compliant inspection. Present in facility were 4 staff supervising 17 children. Children present had been signed in. LPA inspected facility for health and safety hazards.

During inspection, LPA reviewed facility records, interviewed staff and performed site observations. At 3:30PM., Based on record review, LPA confirmed staff's proof of required immunization were missing facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

During the course of this investigation, observations were conducted by LPA on 10/24/2023 and 1/10/2024. A review of facility records was complete which included the Children’s File, Staff Files, and Program Handbook. Interviews were conducted with Staff and Parents. (REFER TO LIC9099c, FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 05-CC-20231016142333
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: HIGHLANDS RECREATION DISTRICT
FACILITY NUMBER: 414001561
VISIT DATE: 01/10/2024
NARRATIVE
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(Page 2)
Regarding the allegation of staff did not prevent day care child from having access to hazardous item; Based on evidence collected, LPA was unable to determine if allegation made is valid. During inspection, LPA observed all off-limit areas were made inaccessible to children in care.

Regarding the allegation of staff did not provide adequate food service to day care children in care; Based on evidence collected, LPA was unable to determine if allegation made is valid. During interviews, staff reported expired food items are immediately discarded.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove a violation did or did not occur, therefore the allegations are Unsubstantiated.



The exit interview was conducted with Interim Director, Stacey Ahlf. The complaint investigation report was and appeal rights were explained and copy was provided.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov.

The ‘Notice of Site Visit’ provided to facility.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 05-CC-20231016142333
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: HIGHLANDS RECREATION DISTRICT
FACILITY NUMBER: 414001561
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/22/2024
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Responsible for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by:
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Interim director will review requirement of constant visual supervision, and watch department resource video with staff by due date: 1/22/2023.
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Based on evidence collected, LPA determine allegation of staff left day care children unattended is valid. 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.
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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: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5