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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005477
Report Date: 11/05/2025
Date Signed: 11/05/2025 11:05:02 AM

Substantiated


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
08/29/2025 and conducted by Evaluator Nicole Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20250829094447
FACILITY NAME:HUMMINGBIRDS COLLABORATIVE SCHOOLFACILITY NUMBER:
214005477
ADMINISTRATOR:RICHARD, MELINDAFACILITY TYPE:
850
ADDRESS:1990 NOVATO BLVD.TELEPHONE:
(415) 760-6197
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:42CENSUS: 28DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Director, Melinda RichardTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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-Staff do not ensure sign in, sign out sheets are being used for children in care
-Staff did not ensure reporting requirements were followed in a timely manner
INVESTIGATION FINDINGS:
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On November 5, 2025, Licensing Program Analysts (LPAs) Tran and Van conducted an unannounced, complaint visit at the above facility. LPAs met with director, Melinda Richard, and explained the purpose of the visit.

Based on record review, LPAs’ observations, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

The facility is being cited two Type B citations for reporting requirements and sign-in/out protocols. A plan of correction was discussed. Appeal rights were provided during visit.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Melinda Richard.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Nicole Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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-20250829094447
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: HUMMINGBIRDS COLLABORATIVE SCHOOL
FACILITY NUMBER: 214005477
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2025
Section Cited
CCR
101212(d)
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101212 Reporting Requirements

(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.

This requirement is not met as evidenced by:
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Center will review the reporting requirements, have a staff training on the topic, and have staff present during the training write their name and sign the meeting agenda and send to LPA Tran.
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Based on record review and interview, the center did not comply with the cited section above by not reporting to the department within 24 hours of the incident, which poses a potential health, safety, and personal rights risk to persons in care.
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Type B
11/21/2025
Section Cited
CCR
101229.1(b)
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101229.1 Sign In and Sign Out

(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
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Center will have a staff training on sign in/out protocols, have staff present during the training write their name and sign the meeting agenda, and email enrolled children's parents the new sign-in/out protocol. Center will send proof of training and email to LPA Tran.
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Based on record review and interview, the center did not comply with the cited section above by not having children signed in/out by their parents/guardians, which poses a potential health, safety, and personal rights risk to persons in care.
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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: Ali Zebila
LICENSING EVALUATOR NAME: Nicole Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2