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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414005024
Report Date: 01/26/2024
Date Signed: 01/26/2024 03:28:07 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
11/09/2023 and conducted by Evaluator Leslit Tapia-Mandujano
COMPLAINT CONTROL NUMBER: 05-CC-20231109092608
FACILITY NAME:SAN CARLOS-BELMONT AFTER SCHOOLFACILITY NUMBER:
414005024
ADMINISTRATOR:PERINO, ANTHONYFACILITY TYPE:
840
ADDRESS:3100 ST. JAMES ROADTELEPHONE:
(650) 226-5031
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:150CENSUS: 103DATE:
01/26/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Co Directors, Anthony Perino and Katrina San FelipeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
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9
Staff left child in soiled clothing for a long period of time.
Staff did not prevent children from bullying other children while in care.
INVESTIGATION FINDINGS:
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2
3
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5
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8
9
10
11
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On January 26th, 2024 at approximately 1:10pm, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced inspection and met with Co-Directors, Katrina San Felipe and Anthony Perino. Purpose of the inspection was explained, and it was to report the investigations finding for the above allegations. Complaint was received by the Department on 11/09/24. Present in the facility are Directors and 9 staff caring for a total 103 school age children. During today's inspection, LPA and Director inspected the facility for health and safety hazards and conducted interviews.

During the course of the investigation, health and safety inspections and staff interviews were conducted. LPA also received and reviewed pertinent documents. Due to the interviews, inspections, and record reviews that were conducted, it was determined that there is not sufficient evidence to prove that the Staff left child in soiled clothing for a long period of time, as well as Staff did not prevent children from bullying other children while in care.

Although the allegation above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the above allegation is UNSUBSTANTIATED.
Upon receipt of this report, Facility shall post the Notice of Site Visit for 30 consecutive days. Failure to maintain posting as required will result in an immediate $100 civil penalty. This report is public and can be reviewed.

Exit interview was conducted and report was reviewed by Director, Anthony Perino.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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