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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414005273
Report Date: 11/12/2025
Date Signed: 11/12/2025 03:13:18 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
09/30/2025 and conducted by Evaluator Janet Gil
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20250930150610
FACILITY NAME:GUSTAVSON, DANIELLE R.FACILITY NUMBER:
414005273
ADMINISTRATOR:GUSTAVSON, DANIELLE R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 515-9618
CITY:PACIFICASTATE: ZIP CODE:
94044
CAPACITY:14CENSUS: 8DATE:
11/12/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Danielle R. GustavsonTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Unlicensed care being provided.
INVESTIGATION FINDINGS:
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On November 12th, 2025, at approximately 1:50 PM, Licensing Program Analyst's (LPAs) Janet Gil and Ruhi Wadhwa arrived at 251Berendos Ave, Pacifica, CA, 94044 to conduct an subsequent unannounced visit regarding the above allegation. The purpose of the visit was explained, and entrance was granted by the operator/adult resident, Danielle R. Gustavson(A1).

During the inspection LPAs observed that A1 provides care and supervision to children at this residential home which requires a State Child Care License. Based on observations and interviews with relevant parties, LPAs confirmed that childcare is being provided at this address. Present in the home were A1, Maria Ospino, (friend/assistant) and 8 school age children. Per A1, 2 children present are her own children.

LPAs observed children being dropped off at the home. Based on LPA's observations and interview with relevant parties, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

Countinue on Page 2...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
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 3
Control Number 05-CC-20250930150610
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: GUSTAVSON, DANIELLE R.
FACILITY NUMBER: 414005273
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/12/2025
Section Cited
CCR
102357
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102357: Operation Without a License:
The Department has reason to believe that family child care is being provided without a license.

This requirement is met as evidence by:
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The operator has a scheduled pre-licensing visit for November 14th, 2025, for a relocation change. The operator plans to not care for, or have children present during inspection.
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Based on observations and interviews, the operator did not comply with the above by providing unlicensed child care. This poses an immediate risk to the health, safety, or personal rights of persons in care.
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Failure to do so will result in civil penalty specified in Section 102357(b)(1) shall be imposed of $200/day if the occupant of an unlicensed facility refuses to seek licensure or the occupant seeks licensure and is denied but continues to operate.
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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: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20250930150610
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: GUSTAVSON, DANIELLE R.
FACILITY NUMBER: 414005273
VISIT DATE: 11/12/2025
NARRATIVE
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Page 2 continued ....


LPAs informed A1, Danielle R. Gustavson, that this report dated 11/12/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the A1, Danielle R. Gustavson, to provide a copy of this licensing report dated 11/12/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

See LIC9099-D for Type A deficiency cited today. Appeal rights were provided to the operator.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Danielle R. Gustavson.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3