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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414002627
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:16:52 PM

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
08/22/2023 and conducted by Evaluator Nathan Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230822104132
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: 5DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Carrie RussellTIME COMPLETED:
02:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee caused injuries to child in care
Licensee hit child in care
Licensee pushed child in care
Licensee forced child in care to nap
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 12, 2023, Licensing Program Analyst (LPA), Garcia conducted an unannounced conclusionary complaint visit and met with licensee, Carrie Russell to discuss the above allegations. Purpose of the inspection was explained. Present are, 2 helpers with the licensee taking care of 5 children.

During the course of the investigation, interviews were conducted with staff members and relevant documents were gathered. Based on the interviews and relevant documents, there was no sufficient evidence to prove that the allegations listed above, occured. Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

LPA conducted exit interview with Licensee, Carrie Russell.

Report and Notice of Site Visit was provided.

Notice of Site Visit shall be posted for 30 consecutive days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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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