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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414000839
Report Date: 08/04/2025
Date Signed: 08/11/2025 03:43:52 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
05/19/2025 and conducted by Evaluator Ruhi Wadhwa
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20250519103245
FACILITY NAME:CHAMPIONS-JOHN MUIR ELEMENTARY (SA)FACILITY NUMBER:
414000839
ADMINISTRATOR:TREVISAN, NOELFACILITY TYPE:
840
ADDRESS:130 CAMBRIDGE LANETELEPHONE:
(650) 797-4310
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:75CENSUS: 30DATE:
08/04/2025
UNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Noel TrevisanTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to children while outside of the facility.
INVESTIGATION FINDINGS:
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On 8/4/2025, Licensing Program Analysts (LPAs) Wadhwa and Gomez conducted an unannounced complaint visit and met with the Director, Noel Trevisan. LPAs explained the purpose of the visit. Present during today’s visit were 30 children and 5 staff.

During the investigation site observations were conducted on 5/21/2025, 5/23/2025, 6/09/2025, 6/19/2025,7/07/2025 and 8/04/2025. A review of the facility records was also completed, and included children’s files, staff files and parent handbook. Interviews were conducted with staff, a sample of the children and the parties involved.

Based on interviews, record review and observation, LPAs were unable to determine
if staff did not provide adequate supervision to children while outside of the facility.
During interviews, it was reported that supervision is consistently provided outdoors.
Continued on Page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Ruhi Wadhwa
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
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-20250519103245
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: CHAMPIONS-JOHN MUIR ELEMENTARY (SA)
FACILITY NUMBER: 414000839
VISIT DATE: 08/04/2025
NARRATIVE
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Page 2

Based on the information obtained from the LPA investigation, the allegation listed above was unsubstantiated, meaning it may have happened or is valid, there is no preponderance of evidence to prove the violations did or did not occur.


Exit interview conducted and report was reviewed with Director, Noel Trevisan.

A copy of the report will be emailed to the Director along with a Notice of Site Visit, that must remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Ruhi Wadhwa
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2