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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005550
Report Date: 04/18/2022
Date Signed: 04/18/2022 12:34:24 PM

Unsubstantiated


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
04/13/2022 and conducted by Evaluator Sheran Lo
COMPLAINT CONTROL NUMBER: 05-CC-20220413113900
FACILITY NAME:C.A.M. (CFS) DE COLORES (PS)FACILITY NUMBER:
214005550
ADMINISTRATOR:LOMBARDI, KELSEYFACILITY TYPE:
850
ADDRESS:1123 COURT STREETTELEPHONE:
(415) 526-7500
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:33CENSUS: 27DATE:
04/18/2022
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Paula CifuentesTIME COMPLETED:
11:21 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not provide a shaded rest area for the children in care.

Facility is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/18/22, Licensing Program Analyst (LPA) Sheran Lo conducted a 10- day complaint inspection in response to the above allegation. LPA met with the Site Manager Paula Cifuentes and explained the purpose of the inspection. Present in the facility is the site manager, 5 teaching staff, and 27 children.

During today’s inspection, LPA obtained copies of the updated children’s roster, personnel report and observed the facility. Based on the interview and observation, there was no sufficient evidence to prove the facility does not provide shade and in disrepair. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated.

LPA conducted exit interview with Manager. Report and Notice of Site Visit will be emailed to pacifuentes@camarin.org by the end of business day. Notice of Site Visit shall be posted for 30 consecutive days.
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
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 3