<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414000839
Report Date: 12/16/2025
Date Signed: 12/16/2025 04:09:01 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
10/01/2025 and conducted by Evaluator Ruhi Wadhwa
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20251001102051
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:120CENSUS: 69DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Gesmyne BellTIME COMPLETED:
04:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure facility doorway is clear of obstruction.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/16/2025 at 1:45 PM, Licensing Program Analysts (LPAs) Wadhwa and Ly conducted unannounced complaint inspection. LPAs met with Area Manager, Gesmyne Bell explained the purpose of the visit. Present during today's inspection were 7 staff, and 69 school-age children. Facility was inspected for health and safety hazards.

Based on site observations, and interviews conducted during the course of this investigation, it was confirmed that a baby gate was installed briefly in the doorway to prevent children from leaving the classroom.
Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. A Type B violation has been issued for obstructing the doorway in accordance with the Title 22 Division 12 of California Code of Regulations. See LIC 809D.

A copy of this report with the appeal rights was provided, and signature of this form acknowledges the receipt of these documents.

Exit interview conducted and report was reviewed with Area Manager, Gesmyne Bell.

Area Manager was advised Notice of Site Visit to remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Ruhi Wadhwa
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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-20251001102051
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2025
Section Cited
CCR
101238(c)
1
2
3
4
5
6
7
101238 Buildings and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
On 10/3/2025, LPAs informed Director Noel Trevisan, that doorways/exits must be kept clear of obstruction. As a result Director removed the baby gate right away and stated the facility would discontinue to use the baby gate.
8
9
10
11
12
13
14
Based on site observations, and interviews conducted during the course of this investigation, it was confirmed that a baby gate was installed briefly in the doorway to prevent children from leaving the classroom.
8
9
10
11
12
13
14
The citation is cleared on this day and a clear of deficiency letter was provided to Area Manager, Gesmyne Bell.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Ruhi Wadhwa
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2