<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005583
Report Date: 08/09/2019
Date Signed: 08/09/2019 02:38:03 PM

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:MISS SANDIE'S SCHOOL-PRESCHOOLFACILITY NUMBER:
213005583
ADMINISTRATOR:DECKER, PAMFACILITY TYPE:
850
ADDRESS:2001 CENTER ROADTELEPHONE:
(415) 892-2712
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:197CENSUS: DATE:
08/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angela BArrientosTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Farhan Bashir-Tariq conducted a case management inspection today in response to an unusual incident report received on July 30, 2019. Facility self reported the incident. The incident involved a lack of supervision that resulted when a teacher, responsible for supervising a group of 5 preschool children, walked out of the room with the other children, leaving a child in the classroom without direct visual observation.
During today's inspection, LPA inspected the room, where the incident took place. LPA Spoke to the Director Angela Barrientos and Teacher Kimberely Wenneberg (S1). Based on the statements obtained from witnesses, it was determined that a lack of care and supervision resulted when on July 22, 2019, when S1 left a prechool child in the classroom while taking the other children out to the playground. S1 was not maintaining direct visual observation of the child during this period of time.
Management and executive staff responded immediately to the occurrence of this incident and spoke to S1 to discuss policies and procedures for providing care and supervision to children at all times. Staff involved in the incident received a written notice of action regarding the lack of supervision incident.
As a result, the following Title 22 deficiency is being cited on the following page: See LIC 809D. An exit interview was conducted and Plans of corrections were reviewed and developed with the Director. Appeal Rights were provided and discussed with the Director. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.
This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.
Licensee was advised any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISS SANDIE'S SCHOOL-PRESCHOOL
FACILITY NUMBER: 213005583
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2019
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
Responsibility For Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).Supervision shall include visual observation.
This requirement is not met as evidenced by confirmation that
1
2
3
4
5
6
7
The Facility has already acted to correct the deficiency: staff involved was spoken to about care and supervision guidelines for children and the requirement of visual observation.
8
9
10
11
12
13
14
a lack of supervision occurred when teacher responsible for supervising a group of 5 preschoolers left a child in the classroom unattended without direct visual observation.
This poses an immediate health and safety risk to the children in care.
8
9
10
11
12
13
14
Facility is also implenting a new daily roll call procedure that includes name to face checks throughout the day.

This deficiency is considered corrected and cleared as of today.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2