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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415328
Report Date: 06/20/2024
Date Signed: 06/20/2024 10:00:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2024 and conducted by Evaluator Sidney Cortez
COMPLAINT CONTROL NUMBER: 52-CC-20240607125555
FACILITY NAME:STANFORD MADERA GROVE CHILDREN'S CENTERFACILITY NUMBER:
434415328
ADMINISTRATOR:ZARCONE, SALLYFACILITY TYPE:
830
ADDRESS:751 OLMSTED ROADTELEPHONE:
(650) 721-6632
CITY:STANFORDSTATE: CAZIP CODE:
94305
CAPACITY:60CENSUS: 30DATE:
06/20/2024
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Kimberly KostepenTIME COMPLETED:
12:18 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of Supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On June 20, 2024 Licensing Program Analyst (LPA) Sidney Cortez met with Director Kimberly Kostepen to deliver the findings for the complaint investigation. Present on this visit is 15 fingerprint cleared teachers, and 30 children.

Based on the interviews conducted and observation, the allegation that a daycare child was left unsupervised- although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.


An exit interview was conducted with the Director and a Notice of Site Visit was provided
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney CortezTELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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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