Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414002877
Report Date: 06/14/2018
Date Signed: 06/14/2018 11:33:57 AM


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
04/02/2018 and conducted by Evaluator Cindy Mok
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20180402084759
FACILITY NAME:PFS-BAYSHORE MIDWAY CDC (PS)FACILITY NUMBER:
414002877
ADMINISTRATOR:CREEDON, JEANNIEFACILITY TYPE:
850
ADDRESS:45 MIDWAY DRIVETELEPHONE:
(415) 330-1717
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY:95CENSUS: 69DATE:
06/14/2018
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marisol Ostorga, and Crystal PlascenciaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Faciltiy staff inappropriately touch child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mok, conducted an unannounced closing complaint inspection. LPA met with the site director, Marisol Ostorga, and Assistant Site Director, Crystal Plascencia. The purpose of the inspection was explained to her. There were 69 children with 16 staff present upon LPA arrival. The Investigation was conducted by the Investigator, Shanie Humbert Rico from the Investigation Branch. Although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation was found to be UNSUBSTANTIATED.

An exit inspection was conducted with Marisol Ostorga and appeal rights were explained. A printed copy of the report was provided to the Licensee at the conclusion of the inspection. Notice of site visit was posted and must remain posted for 30 days for public review.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2018
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