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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414005048
Report Date: 08/05/2025
Date Signed: 08/05/2025 01:11:44 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
07/29/2025 and conducted by Evaluator Diana Alvarado
COMPLAINT CONTROL NUMBER: 05-CC-20250729144538
FACILITY NAME:TSAGAAN, SARANTUYAFACILITY NUMBER:
414005048
ADMINISTRATOR:TSAGAAN, SARANTUYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 517-6919
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:14CENSUS: 4DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Sarantuya TsagaanTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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-Licensee did not prevent infant in care from sustaining a sunburn at the facility
-Licensee failed to report incident
INVESTIGATION FINDINGS:
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On 8/5/2025, at approximately 8:45AM, Licensing Program Analysts (LPAs) Alvarado and Tse conducted an unannounced complaint visit. LPAs met with Licensee, Sarantuya Tsagaan (L1), and explained the purpose of the visit. Present during the visit was L1 and Assistant supervising 4 infants.

Based on observations, record review, and interviews with relevant parties, LPAs confirmed that an infant was exposed to direct sunlight, and sustained a sunburn. Licensee stated that the infant was placed in the sun for 30 minutes. LPAs advised Licensee that infants under 6 months of age should not be exposed to direct sunlight. The preponderance of evidence standard has been met, therefore the allegation that “Licensee did not prevent infant in care from sustaining a sunburn at the facility” is found to be SUBSTANTIATED.

LPA conducted a file review of the facility’s files and did not observe documentation of incident reports submitted to the Regional Office concerning the incident. Based on interviews and record review, the preponderance of evidence standard has been met, therefore the allegation that “Licensee failed to report incident” is found to be SUBSTANTIATED.

Continued on Page 2...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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-20250729144538
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: TSAGAAN, SARANTUYA
FACILITY NUMBER: 414005048
VISIT DATE: 08/05/2025
NARRATIVE
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See LIC9099-D for deficiencies cited regard Personal Rights and Reporting Requirements.

LPA Alvarado informed facility representative Sarantuya Tsagaan that this report dated 8/5/2025 documents one Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Alvarado informed the facility representative to provide a copy of this licensing report dated 8/5/2025 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal rights were provided and explained. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Sarantuya Tsagaan.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20250729144538
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: TSAGAAN, SARANTUYA
FACILITY NUMBER: 414005048
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2025
Section Cited
CCR
102423(a)(2)
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102423 (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2)To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
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Licensee will ensure that infants are under proper protection such as umbrellas or covers to ensure that theri is no direct sun exposure. Licensee will also submitt phtos of a placed canopy outdoors that will provide shade for children outdoors. Licensee will submitt phtos via email to LPA Alvarado by 8/6/25.
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Based on observation, record review and interview, the licensee did not comply with the section cited above in one out of one person in care, the licensee did not ensure that an infant was not exposed to direct sunlight resulting in a sunburn.
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Type B
08/15/2025
Section Cited
CCR
102416.2(b)
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102416.2(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.

This requirement is not met as evidenced by:
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Licesnee will submitt a written plan to LPA Alvarado by 8/15/25 in regards to actions that will be taken in the event an indcient does occur.
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Based on record review and interview, the licensee did not comply with the section cited above in not reporting an incident that occured duing the operation if the facility.
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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: Diana Alvarado
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3