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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004603
Report Date: 08/21/2026
Date Signed: 08/21/2026 02:28:06 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
06/25/2026 and conducted by Evaluator Katie Krenn
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20260625163622
FACILITY NAME:TRINITY LUTHERAN PRESCHOOLFACILITY NUMBER:
414004603
ADMINISTRATOR:EYVAZOV, JAMFACILITY TYPE:
850
ADDRESS:1248 BALBOA AVENUETELEPHONE:
(650) 580-2349
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:26CENSUS: 13DATE:
08/21/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jam EyvazovTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to the daycare children.
Staff left daycare children unattended.
INVESTIGATION FINDINGS:
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On August 21, 2026, Licensing Program Analyst (LPA) Katie Krenn arrived at the facility to close a complaint investigation in response to the above complaint allegation(s). LPA met with Director, Jam Eyvazov and explained the purpose of today's visit. In addition to the director, there are four staff supervising 13 preschool children.

During the course of the investigation, LPA conducted interviews, observations, and pertinent documentation provided by parties involved. Based on the information gathered, the preponderance of evidence standard has been met, therefore the above allegations are found SUBSTANTIATED.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted with Director, Jam Eyvazov and appeal rights were reviewed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Katie Krenn
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026
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 2
Control Number 05-CC-20260625163622
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: TRINITY LUTHERAN PRESCHOOL
FACILITY NUMBER: 414004603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2026
Section Cited
CCR
101229
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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) 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.
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The facility shall ensure adaquate supervision and that no child(ren) shall be left without the supervision and that supervision shall include visual observation at all times that children are in care.
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This requirement is not met as evidenced by:

A child was without supervision for an undetermined amount of time.
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The facility has decided to put in additional outdoor security cameras.

The facility shall also ensure that all the exits have active alarms.
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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.
SUPERVISOR'S NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Katie Krenn
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2