Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414002577
Report Date: 07/06/2016
Date Signed 07/06/2016 02:33:50 PM


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
04/28/2016 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20160428161058
FACILITY NAME:PHOU, RINAFACILITY NUMBER:
414002577
ADMINISTRATOR:PHOU, RINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 724-4757
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:14CENSUS: 7DATE:
07/06/2016
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Marisol Negrete, Lalaine GumbanTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
LICENSE: Facility is operating over capacity
PHYSICAL PLANT: Staff smoke in the home
PERSONAL RIGHTS: Inappropriate discipline
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Andrea Medlin met with staff for this conclusionary complaint visit. Purpose of the visit explained. There were 7 children present during the visit. Interviews have been conducted with staff; observation of the facility; and children's roster and schedule obtained.The allegation regarding children being inappropriately disciplined cannot be proven or unproven. According to staff, the discipline policy is redirection and time outs. It is unknown whether any child was ever inappropriately disciplined. Based on information gathered, there are 13 children enrolled in the daycare, however schedules vary and there are many "drop ins." Licensee states she never has more than 12 children in care at a time. Based on available information, it appears facility is operating within capacity and ratios at this time. It is unknown whether there was a time prior to the two visits that facility operated out of ratio. Staff deny smoking in the home and there is no evidence to corroborate this.

Based on the Department's investigation, it was determined that there was a lack of sufficient evidence to support or deny the allegations. Based on this information, the findings of the allegations are inconclusive.

This report was reviewed with staff and a copy of this report must be available for public review upon request. Notice of Site Visit shall remain posted for 30 days.
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2016
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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