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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005550
Report Date: 03/02/2023
Date Signed: 03/02/2023 01:00:43 PM

Unsubstantiated


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
02/09/2023 and conducted by Evaluator Hanson Leong
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230209142804
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: 23DATE:
03/02/2023
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Sheryl WesleyTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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- Staff did not report injuries to child's authorized representative in a timely manner
INVESTIGATION FINDINGS:
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On 3/2/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced conclusionary complaint visit to the C.A.M De Colores Preschool facility. The LPA was granted entry by the Substitute Director. Sheryl Wesley. The LPA explained the purpose of the visit to the substitute director. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed eight staff members supervising twenty-three preschool age children. Children's capacity and ratio requirements were observed to be in compliance

All relevant information was gathered and analyzed during the investigation, and all parties involved were contacted and interviewed. Based on information obtained from the LPA investigation, the allegation, staff did not report injuries to child's authorized representative in a timely manner, may have happened or are valid, there is not a preponderance of evidence to prove the violation did or did not occur; therefore, the above allegation is found to be unsubstantiated.
***See Page 2 for continuation***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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-20230209142804
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: C.A.M. (CFS) DE COLORES (PS)
FACILITY NUMBER: 214005550
VISIT DATE: 03/02/2023
NARRATIVE
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Continued, Page 2
A copy of this report and the “Notice of Site Visit” were given to Sheryl Wesley.

“The Notice of Site Visit” shall be posted for 30 days.

Failure to maintain postings as required, will result in an immediate $100 civil penalty

Exit interview conducted and report was reviewed with the Substitute Director, Sheryl Wesley.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2