Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414002577
Report Date: 10/24/2018
Date Signed 10/24/2018 04:48:00 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
10/22/2018 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20181022102815
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: 8DATE:
10/24/2018
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Rina Phou, Amy Lee, Samantha SoukkampTIME COMPLETED:
04:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PHYSICAL PLANT: Facility has rodents (mice)
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Andrea Medlin met with Licensee and two helpers for this complaint visit. Purpose of the visit explained. There are 8 children present during the visit; 3 infants and 5 preschool aged. Physical plant toured to inspect for any health and safety hazards. LPA did not observe any rodents in the home or traps. Licensee acknowledged that there was a mouse seen in the garage to which has been trapped and the landlord was called and fixed a gap in the garage to prevent any openings. Per Licensee and helpers, they state they have not seen any mice or rodents inside the house or daycare areas.

The Department has investigated the above allegation. Although the allegation of rodents in the facility may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is found to be 'Unsubstantiated.'

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

DATE: 10/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2018
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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