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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410518747
Report Date: 04/15/2025
Date Signed: 04/15/2025 03:54:47 PM

Unsubstantiated


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
02/28/2025 and conducted by Evaluator Leslit Tapia-Mandujano
COMPLAINT CONTROL NUMBER: 05-CC-20250228094143
FACILITY NAME:RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOLFACILITY NUMBER:
410518747
ADMINISTRATOR:PENA, ROXANAFACILITY TYPE:
850
ADDRESS:701 CHARTER ST, PORT 1,2,3,& 4TELEPHONE:
(650) 482-2407
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:105CENSUS: 48DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Site Supervisor, Roxana PenaTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in child sustaining an injury
INVESTIGATION FINDINGS:
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On April 15th, 2025 at approximately 11:40am, Licensing Program Analysts (LPAs) Tapia-Mandujano and Wadhwa conducted an unannounced inspection to conclude the pending complaint investigation. LPAs met with Site Supervisor, Roxana Pena regarding the above allegation and explained the purpose of the visit. Present in the facility are Site Supervisor and 13 teachers caring for 48 preschool age children. All adults working at the facility have fingerprint clearance through the Redwood City School District.

During the today’s inspection, LPAs and Site Supervisor toured the facility for health and safety hazards and conducted two staff interviews.

Complaint was received by the Department on 02/28/25. During the course of the investigation, interviews were conducted with staff at the facility. Interviews with involved parties were conducted. As well as relevant documents were gathered.

Continued on Page 2...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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-20250228094143
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: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL
FACILITY NUMBER: 410518747
VISIT DATE: 04/15/2025
NARRATIVE
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Based on interviews and information that was gathered, it was determined that an incident did occur where a child was injured by a toy that was thrown by another child during outdoor play. During interviews, it was determined that two separate staff observed the incident happen and attempted to intervene to prevent the child from getting hurt but were unsuccessful. The facility was proactive by removing the toys (balancing steps) completely from the outdoor playground and having a training about Safety Protocols for Outdoor play on February 26th, 2025.

LPAs determined that based on the information obtained there is not sufficient evidence to state that the staff did not provide adequate supervision resulting in child sustaining an injury.

Although the allegation above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the above allegation are UNSUBSTANTIATED.

Upon receipt of this report, Licensee shall post the Notice of Site Visit. Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.

After today’s visit, an exit interview was conducted, report was reviewed and copy was provided to Site Supervisor, Roxana Pena.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
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