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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004526
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:31:13 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
02/08/2024 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240208131544
FACILITY NAME:SAFARI KID MENLO PARKFACILITY NUMBER:
414004526
ADMINISTRATOR:MENON, SANDHYAFACILITY TYPE:
850
ADDRESS:107 CLOVER LANETELEPHONE:
(650) 322-0192
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:24CENSUS: 13DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Sandhya MenonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff does not meet the qualifications to care and supervise day care children.
INVESTIGATION FINDINGS:
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On February 23rd, 2024, Licensing Program Analyst (LPA) Kassandra Medrano met with Licensee, Sandhya Menon. Purpose of inspection was explained and was for an unannounced subsquent complaint inspection. Present was the licensee, 13 children, and 2 staff. All individuals present in the center have received fingerprint clearance to work or be in a childcare center. The center is operating within its capacity and in accordance with the required ratio of staff to children. LPA Medrano inspected facility for health and safety hazards.

During today’s inspection, LPA conducted record review, requested required documents, and interviewed staff and licensee. During the course of this investigation, All relevant information was gathered and analyzed during the investigation. Based on information obtained from the investigation, it was found that S3 was lefft alone at facility without qualified staff on site. The preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
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 3
Control Number 05-CC-20240208131544
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: SAFARI KID MENLO PARK
FACILITY NUMBER: 414004526
VISIT DATE: 02/23/2024
NARRATIVE
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LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH APPLICANT/PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

This TYPE A citation page shall be posted for 30 days along with the “Notice of Site Visit.” This page shall be provided to all parents of children currently enrolled, and any future children being enrolled for the next 12 months per AB 633 requirements.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

Exit interview conducted and report was reviewed with Sandhya Menon.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20240208131544
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: SAFARI KID MENLO PARK
FACILITY NUMBER: 414004526
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/01/2024
Section Cited
CCR
101216.1(b)(2)
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101216.1 Teacher Qualifications and Duties
(b) Prior to employment, a teacher shall meet the requirements of (b)(1) or (b)(2) below:(2)A teacher shall meet the requirements of Health and Safety Code Section 1597.055.

This requirement was not met as evidenced by:
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Licensee stated that moving forward staff will have staff on site until education requirements are met. She will provide a written statement acknowledging requirement for S3 "training period"
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Based on interviews with staff and documents reviewed it was found that S3 has been left on site with children without any other staff present. S3 has 6 units complete and is in process fro the remainder of units required. This poses an immediate health and safety risk to children in care.
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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: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
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