Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414002877
Report Date: 05/03/2019
Date Signed: 05/03/2019 10:06:06 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
02/27/2019 and conducted by Evaluator Cindy Mok
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20190227145220
FACILITY NAME:PFS-BAYSHORE MIDWAY CDC (PS)FACILITY NUMBER:
414002877
ADMINISTRATOR:MARISOL OSTORGAFACILITY TYPE:
850
ADDRESS:45 MIDWAY DRIVETELEPHONE:
(415) 330-1717
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY:95CENSUS: 85DATE:
05/03/2019
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Crystal PlascenciaTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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9
* Lack of Supervision resulting inappropriate interactions between children in care.

* Staff hit child in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mok conducted an unannounced inspection to finalize this complaint. LPA met with the Assistant Site Director, Crystal Plascencia. The purpose of the inspection was explained to her. There were 85 children with 15 staff present. During the investigation, LPA conducted interview with staff and witnesses. Based on the interviews, there was no sufficient evidence to prove staff hit the child in care and lack of supervision resulting insppropriate interactions between children in care.

Although the allegations may have happened or are valid, there was not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation was Unsubstantiated.


An exit inspection was conducted with Assistant Site Director and appeal rights were explained. A printed copy of the report, as well as a printed copy of the appeal rights, were 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: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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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