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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102937
Report Date: 09/26/2019
Date Signed: 09/26/2019 10:37:52 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:STRAWBERRY PRESCHOOLFACILITY NUMBER:
210102937
ADMINISTRATOR:WOODS, LISA C.FACILITY TYPE:
850
ADDRESS:240 TIBURON BOULEVARDTELEPHONE:
(415) 388-4437
CITY:TIBURONSTATE: CAZIP CODE:
94920
CAPACITY:60CENSUS: DATE:
09/26/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lisa WoodsTIME COMPLETED:
10:30 AM
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On 09/26/19 at 9:00 A.M., Licensing Program Analyst (LPA) Van conducted an unannounced case management and met with the director Lisa Woods. The purpose of this inspection was explained and was granted entry to inspect the facility by the director. Facility self reported an unusual incident that occurred on Sept 10, 2019. Present there are 49 children and 8 teachers.

On the above mentioned incident, a child was sustained an injury to her lower lip, resulted from tripping over the leg of a chair while lining up to wash her hands. In today’s inspection, LPA interviewed teachers that observed the incident, and director. Teacher S1 stated that C1 was distracted when S2 called the name of the other child. C1 turned and kept walking. According to S1 and S2, that was when C1 tripped over the leg of a chair and bumped her mouth on another chair. Based on the evidence obtained, it was determined to be an accident, and supervision was not the issue. On the mentioned date there were 8 staff and 46 children, facility was in ratio at the time of the incident. There were no deficiencies discovered or observed.

Notice of site visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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