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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414000469
Report Date: 07/19/2024
Date Signed: 07/19/2024 12:57:28 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
04/30/2024 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240430081030
FACILITY NAME:SSFUSD CHILDREN'S CENTER PRESCHOOLFACILITY NUMBER:
414000469
ADMINISTRATOR:SHAMSHAD KHALILFACILITY TYPE:
850
ADDRESS:530 TAMARACK LANETELEPHONE:
(650) 827-8400
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:105CENSUS: 36DATE:
07/19/2024
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Shamshad KhalilTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff used inappropriate forms of punishment with children in care
Staff inappropriately touched child in care
INVESTIGATION FINDINGS:
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On 7/19/2024 at 8:35AM., Licensing Program Analyst (LPA), Luis Gomez met with Program Supervisor, Shamshad Khalil. The purpose of today's inspection was explained and was for an unannounced, complaint investigation. Present was the Program Supervisor and 11 staff supervising 36 children. Children present had been properly signed in by Guardians. Facility was inspected for health and safety hazards.

During inspection, LPA performed observation, interviews, and reviewed facility records.

As part of this investigation, observations were conducted on 5/7/2024, 6/25/2024, and 7/19/2024. LPA completed review of the facility records, which included the children files, personnel files, and parent handbook. LPA conducted interviews with program supervisor, staff, guardian, and children (REFER TO 809C FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
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 4
Control Number 05-CC-20240430081030
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: SSFUSD CHILDREN'S CENTER PRESCHOOL
FACILITY NUMBER: 414000469
VISIT DATE: 07/19/2024
NARRATIVE
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(Page 2)
Based on the evidence collected; LPA was unable to determine if staff used an inappropriate form of punishment with children in care. During interviews, staff reported using appropriate intervention strategies when assisting children with behavioral needs.

Based on the evidence collected; LPA was unable to determine staff inappropriately touched child in care. Parent handbook states, staff assist children by providing verbal guidance and modeling words to solve problems.

Although allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated. No Deficiencies were cited.

LPA conducted exit interview with the Shamshad Khalil Report was explained and Notice of Site Visit was given.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4