Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002202
Report Date: 04/14/2017
Date Signed 04/14/2017 10:34:19 AM


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
03/10/2017 and conducted by Evaluator Tony Ng
COMPLAINT CONTROL NUMBER: 05-CC-20170310085647
FACILITY NAME:FACESSF - HAYES VALLEY CDC (INFANT)FACILITY NUMBER:
384002202
ADMINISTRATOR:BACSAFRA, APRIL O.FACILITY TYPE:
830
ADDRESS:305 BUCHANAN STREETTELEPHONE:
(415) 552-1535
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:18CENSUS: 13DATE:
04/14/2017
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:April BacsafraTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff speaks harshly to child
Facility staff forcing child to take a nap
Facility staff not cleaning the children's toys regularly
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Ng made a closing complaint visit to the facility at issue, present was the director with 4 staff members and 13 children. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. The finding is comprised of interviews with parents and staff as well as multiple visits to the facility to observe practices being performed. Information available shows that there were personal issues amongst the staff and that the information made available to the department was hearsay.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2017
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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