<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 210110016
Report Date: 10/11/2023
Date Signed: 01/08/2024 12:36:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
09/01/2023 and conducted by Evaluator Nathan Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230901115108
FACILITY NAME:FAIRFAX SAN ANSELMO CHILDREN'S CENTER-INFANT PROGRFACILITY NUMBER:
210110016
ADMINISTRATOR:TOMSKY, HEIDIFACILITY TYPE:
830
ADDRESS:199 PORTEOUS AVENUETELEPHONE:
(415) 454-1811
CITY:FAIRFAXSTATE: CAZIP CODE:
94930
CAPACITY:19CENSUS: 10DATE:
10/11/2023
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Heidi TomskyTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
***** THIS IS AN AMENDED REPORT FROM ORIGINAL DATED 10/11/23 *****
Staff have not ensured the facility grounds are safe for daycare children.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
***** THIS IS AN AMENDED REPORT FROM ORIGINAL DATED 10/11/23 *****
On October 11, 2023, Licensing Program Analyst (LPA) Garcia and Licensing Program Manager (LPM) Oquendo conducted an unannounced conclusionary complaint visit and met with director, Heidi Tomsky and program director, Eric Schweninger to discuss the above allegation. The purpose of the inspection was explained. Present with the director were 10 children and 5 teachers in the infant program. The Preschool program had 18 children and 5 teachers. The school aged program was not in session during the visit.

During the visit, LPA and LPM observed and inspected the three licenses housed under the same property, preschool license number 210110015, school age license number 210110017 and the infant license number 210110016.

During the investigation, interviews were conducted, observations were made, and pertinent documentation was reviewed. The agency has determined that the allegation of "Staff have not ensured the facility grounds are safe for daycare children." are SUBSTANTIATED, meaning the preponderance of evidence standard has been met.

LIC 9099D is on the next page for the deficiency.

Report, Appeal Rights and Notice of Site Visit was provided.

Notice of Site Visit shall be posted for 30 consecutive days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Hedi Tomsky.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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
Control Number 05-CC-20230901115108
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAIRFAX SAN ANSELMO CHILDREN'S CENTER-INFANT PROGR
FACILITY NUMBER: 210110016
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/13/2023
Section Cited
CCR
101169(d)(3)
1
2
3
4
5
6
7
101169 Application for License
(d) The LIC 281A (12/96) and supporting documents shall together contain the following:
(3) If the applicant is leasing or renting the premises of the child care center, a copy of the lease or rental agreement and the name, address and telephone number of the property owner.

This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
The facility will provide a signed written agreement from the landlord.
8
9
10
11
12
13
14
Based on observations conducted and pertinent documents received, the facility does not have a current lease agreement with the landlord.

This pose a potential health and safety risk to children in care.
8
9
10
11
12
13
14
This facility will send proof by set due date.
Type B
11/13/2023
Section Cited
CCR
101238
1
2
3
4
5
6
7
101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
The facility will make the necessary repairs to the property and send proof to the LPA.
8
9
10
11
12
13
14
Based on observations conducted and pertinent documents received, the facility has missing ceiling panels, signs of water damage, broken windows and exposed wires.

This pose a potential health and safety risk to children in care.
8
9
10
11
12
13
14
The proof of necessary repairs will be sent by set due date.
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: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2