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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410500303
Report Date: 06/14/2024
Date Signed: 06/14/2024 12:04:47 PM

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
01/19/2024 and conducted by Evaluator Catrina Quimbo
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240119150600
FACILITY NAME:HIGHLANDS CHRISTIAN SCHOOLSFACILITY NUMBER:
410500303
ADMINISTRATOR:CAMACHO, CRYSTALFACILITY TYPE:
850
ADDRESS:1900 MONTEREY DRIVETELEPHONE:
(650) 873-4090
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:300CENSUS: 47DATE:
06/14/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Crystal Camacho & Samaa SroujiTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff left a hot liquid accessible to children in care resulting in day-care child sustaining burn injuries.
INVESTIGATION FINDINGS:
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On June 14, 2024 at approximately 9:15am, Licensing Program Analysts (LPAs) Catrina Quimbo and Melissa Zaragoza, conducted an unannounced, complaint visit to Highlands Christian School.

LPAs met with director, Crystal Camacho, and associate director, Samaa Srouji, and explained the purpose of the visit. Present during LPAs' visit included 47 children and 11 teaching staff.

On January 19, 2024, director self-reported the incident above to department. Investigation Bureau (IB) conducted the investigation.

During the investigation, IB Investigator conducted interviews with teaching staff, random selection of enrolled children, random selection of enrolled children’s authorized representatives, reviewed video footage and obtained supportive documentation.
(Continue Report on LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
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
Control Number 05-CC-20240119150600
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: HIGHLANDS CHRISTIAN SCHOOLS
FACILITY NUMBER: 410500303
VISIT DATE: 06/14/2024
NARRATIVE
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(Continued, Page 2...)
Per information gathered by IB, a staff member left a hot liquid on a table in the Toddler Unit classroom. IB found allegation to be substantiated.

Based on IB's observations, interviews and record review which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

California Health and Safety code is being cited. An immediate civil penalty is issued on today's date. Please refer to LIC9099D and LIC921IM for more information.

LPA Quimbo informed director, Crystal Camacho, that this report dated June 14, 2024 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Quimbo informed the director to provide a copy of this licensing report dated June 14, 2024 that documents any Type A citation to parents/guardian of all children enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were also provided during visit.

Exit interview conducted and report was reviewed with facility representatives, Crystal Camacho and Samaa Srouji.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20240119150600
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: HIGHLANDS CHRISTIAN SCHOOLS
FACILITY NUMBER: 410500303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2024
Section Cited
HSC
1597.58(c)(1)
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1597.58 Civil Penalties (c)(1) The department shall assess an immediate civil penalty...for any of the following serious violations...Any violation that the department determines resulted in the injury or illness of a child.
This requirement was not met as evidenced by:
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Child's family was informed of incident on same date. Director self-reported incident to department. Staff member involved was placed on administrative leave. Directos held multiple, mandatory staff meetings reinforcing staff members' food and beverage policies in classrooms.
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Based on observations, interviews, and record review, staff left a hot liquid accessible to children, resulting in a day care child sustaining burn injuries.
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Teaching staffs' beverage containers must have a specific, locked lid and must be kept in high shelves. Teaching staff are not to have hot beverages in classroom. Child has since returned to facility and is per their normal.
Deficiency cleared during visit.
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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: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
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