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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 210108890
Report Date: 07/22/2025
Date Signed: 07/22/2025 02:15:10 PM

Unsubstantiated


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
06/13/2025 and conducted by Evaluator Jaclyn Naves
COMPLAINT CONTROL NUMBER: 05-CC-20250613094923
FACILITY NAME:C.A.M.(CFS)-OLD GALLINAS CHILDREN'S CENTER (PS)FACILITY NUMBER:
210108890
ADMINISTRATOR:LEYDIS MATAFACILITY TYPE:
850
ADDRESS:251 NORTH SAN PEDRO ROADTELEPHONE:
(415) 472-1663
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:140CENSUS: 88DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Lexi HallumTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff pulled an enrolled child's hair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 22, 2025, Licensing Program Analysts (LPAs) Naves and Van conducted an unannounced inspection to finalize this complaint and deliver the findings to the Center. LPAs met with the site Director, Lexi Hallum and Assistant Director Debora Osorio. The purpose of the inspection was explained, and entry to the Center was granted. 22 staff members supervised 88 children today. The teachers and children ratio were met.
Staff and children were interviewed during the investigation, and all relevant documents were obtained and reviewed. As per the information available, there was inadequate evidence to support any claims of Staff pulling children’s hair. During visit Alisa Folda Education and Inclusion manager arrived.The Department has investigated the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the director Lexi Hallum.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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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