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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004818
Report Date: 06/07/2023
Date Signed: 06/07/2023 11:51:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
03/20/2023 and conducted by Evaluator Maria Olguin-Leon
COMPLAINT CONTROL NUMBER: 05-CC-20230320150459
FACILITY NAME:CARBALLO RAMOS, AIDA VIRGINIAFACILITY NUMBER:
414004818
ADMINISTRATOR:CARBALLO RAMOS, AIDA V.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 798-4825
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY:14CENSUS: DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:TIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Licensee is not meeting her 80% at the facility.
Licensee yell at daycare children.
Licensee locked daycare child in bathroom.
Licensee serves daycare childen food of poor quality.
Licensee has inappropriate conversations in the presence of daycare children.
INVESTIGATION FINDINGS:
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On June 7, 2023 at approximately 10:06PM, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced, complaint investigation and met with licensee, regarding above allegations and explained the purpose of the visit. LPA and licensee toured the home for health and safety hazards.

Complaint was received by the Department on 03/20/23. Present in the facility today were licensee, two assistant caring for 8 children (3 infant and 5 preschool age). All adults working or living in the facility have fingerprint clearance and are associated.

During the course of the investigation, interviews were conducted with licensee, parents, involved parties, and relevant documents were gathered. LPA did not observe any of the above allegations.

Although the allegations above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the above allegations are UNSUBSTANTIATED

LPA conducted exit interview with Licensee. Report and Notice of Site Visit was provided. Notice of site visit is to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
03/20/2023 and conducted by Evaluator Maria Olguin-Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230320150459

FACILITY NAME:CARBALLO RAMOS, AIDA VIRGINIAFACILITY NUMBER:
414004818
ADMINISTRATOR:CARBALLO RAMOS, AIDA V.FACILITY TYPE:
810
ADDRESS:379 ELM STREETTELEPHONE:
(650) 798-4825
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY:14CENSUS: DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:TIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff do not practice proper handwashing.
Daycare is unsanitary.
INVESTIGATION FINDINGS:
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On June 07, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon, arrived at the facility unannounced to close the complaint investigation into the above allegation and met with Licensee Aida Virginia Carballo Ramos. Present during the visit were licensee, two assistants, 8 children (3 infants & 5 preschoolers).

Based on investigation and information gathered through interviews and physical tours of the facility, the allegation Staff do not practice proper handwashing, the preponderance of evidence standards has been met, therefore, the above allegation is found to be SUBSTANTIATED. A Type “B” violation was issued today in accordance to the California Code of Regulations, Title 22, Division 12, Chapter 1, citation was being cited on the attached LIC9099D

Cont. on next page

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 05-CC-20230320150459
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CARBALLO RAMOS, AIDA VIRGINIA
FACILITY NUMBER: 414004818
VISIT DATE: 06/07/2023
NARRATIVE
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Based on investigation and information gathered through interviews and physical tours of the facility, the allegation daycare is unsanitary based on not sanitizing diapering area, the preponderance of evidence standards has been met, therefore, the above allegation is found to be SUBSTANTIATED. A Type “B” violation was issued today in accordance to the California Code of Regulations, Title 22, Division 12, Chapter 1, citation was being cited on the attached LIC9099D.

This report and exit interview were conducted and appeal rights was given to Licensee, Aida Virginia Carballo Ramos. Notice of Site Visit shall remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 05-CC-20230320150459
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CARBALLO RAMOS, AIDA VIRGINIA
FACILITY NUMBER: 414004818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2023
Section Cited
CCR
102423(a)(2)
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102423(a)(2): Personal Rights: Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged...(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not me by:
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Licensee has agreed to have all staff trained in proper hand washing protocal.

Licensee will provide docuumentation of completion of training by 07/06/23.
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Based on observation and interviews, the licensee did not comply with the section cited above as proper hand washing conducted before or after diaper changing, which poses a potential health, safety or personal rights risk to persons in care
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Type B
06/08/2023
Section Cited
CCR
102417(b)
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102417 Operation of a Family Child Care Home

(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement is not met as evidence by:
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Licensee has agreed to have all staff trained in properly sanitizing and cleaning diapering area after each diaper changing.

Licensee will provide documentation of completion of training by 07/06/2023.
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Based on tours of family child care home conducted by LPA Olguin-Leon on 03/28/2023, licensee diapering area was not keep clean and sanitized.
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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: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4