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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004456
Report Date: 08/20/2021
Date Signed: 08/20/2021 06:34:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/09/2021 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210609082608
FACILITY NAME:2ND GENERATION CABOT (PS)FACILITY NUMBER:
414004456
ADMINISTRATOR:ALCANTARA, RACHYLFACILITY TYPE:
850
ADDRESS:342 ALLERTON AVETELEPHONE:
(650) 225-3666
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:264CENSUS: DATE:
08/20/2021
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Maryann KlotovichTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulting in injury
Day care child was inappropriately touched while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Andrea Medlin met with regional manager for this conclusionary complaint visit. Initial complaint investigation was conducted on 6/17/2021. Information was gathered in regard to allegations including: both staff and childrens rosters/schedules and supplemental information obtained by our Investigations Branch (IB) relevant to allegations. On previous visit, LPA viewed security camera footage of the alleged incident of child (C1) falling during outside play time resulting in injury. LPA viewed approx 30 minutes of footage showing the children and staff outside. LPA did see the reported child playing outside with other children and occasionaly in view near a staff person. There is no audio in the video. LPA did not see any children fall or any other unusual incidents happen outside during the video clip that was viewed. In addition, LPA did not notice any alarm from staff outside that would have caused them to stop supervising and attend to an injured child. All appears normal in the video with children playing and staff supervising. In regard to allegation of a child inappropriately touched, the Investigations Branch (IB) investigated that allegation, conducted numerous interviews with relevant parites, obtained relevant records related to any possible injury.
(continued next page 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
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-20210609082608
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: 2ND GENERATION CABOT (PS)
FACILITY NUMBER: 414004456
VISIT DATE: 08/20/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on the Investigations Branch (IB) findings, there was not any information that was provided to indicate any record or disclosure of inappropriate touching of a child. (continued on next page 9099-C)

The investigation determined there is not enough available sufficient information to prove a violation occurred.

Although these allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore these allegations are closed as unsubstantiated.

This report is reviewed with regional manager and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2