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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414002627
Report Date: 03/24/2022
Date Signed: 03/24/2022 02:26:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/04/2021 and conducted by Evaluator Marie Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211104095401
FACILITY NAME:RUSSELL, CARRIE J.FACILITY NUMBER:
414002627
ADMINISTRATOR:RUSSELL, CARRIE J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 341-0944
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:14CENSUS: 8DATE:
03/24/2022
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Carrie RussellTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
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9
Adult in the home poses a risk to daycare children while in care.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marie Rodriguez conducted a subsequent unannounced complaint inspection to discuss the above allegation with Licensee Carrie Russell. Present in the home were the Licensee, her husband, her adult son, and 8 children. Allegation was investigated by the Department’s Investigations Branch (IB).

During the course of the investigation, IB Investigator Eddie Phung conducted interviews with Licensee, Licensee’s family, children’s guardians, and other relevant parties and obtained relevant documentation.

Although the allegation that an adult in the home poses a risk to daycare children while in care may have happened or may be vaild, based on the information obtained by IB Investigator Phung, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is found to be UNSUBSTANTIATED.

An exit interview was conducted with Licensee Carrie Russell. A copy of report was provided. Notice of site visit was observed to be posted and shall remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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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