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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005583
Report Date: 01/21/2020
Date Signed: 01/21/2020 01:17:09 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: 144DATE:
01/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Angela BarrientosTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection today. LPA met with the Site Director, Angela Barrentos, and Pam Decker. The purpose of the inspection was explained to them. There were 144 children with 16 staff present. The case management was related to an unusual incident report that was reported by the facility on 12/17/19. The incident actually happened on 12/16/19 around 2:50 pm. A child stuck her hair clip into an electrical outlet and received a minor shock during the nap time. The child stuck a hair clip into the electrical outlet while she stayed in the cot for napping. The teachers were around in the room to provide care and supervision when it happened. Both teachers were about a couple of feet away from the child when it happened. Staff called 911 and parents about the incident immediately. The paramedics showed up within a minute and checked on the child completely to make sure the child was fine. The child was okay. The child wasn't taken to the hospital after the completed check. The child's mother took the child home afterward. The child came back to school on 12/30/19. LPA interviewed the staff and inspected the classroom to health and safety hazards. LPA didn't see any issue on the electrical outlet and set up in the room during the inspection.

* No deficiency was cited during the inspection today*.




This report and notice of site visits were discussed with the licensee and must be made available to the public upon request. For a quarterly update on Licensing information, go to the CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.


SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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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