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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005487
Report Date: 07/08/2021
Date Signed: 07/08/2021 04:00:05 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:GOLDEN POPPY PRESCHOOL & INFANT CENTERFACILITY NUMBER:
214005487
ADMINISTRATOR:BROWN, KELLYFACILITY TYPE:
850
ADDRESS:50 EL CAMINO DRTELEPHONE:
(415) 924-2828
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:109CENSUS: 43DATE:
07/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director Kelly Brown and site director Fatimabibi Mirza TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Jyoti Saini conducted a case management visit today along with a complaint investigation. In the course of conducting the investigation, LPA inspected the facility and observed violation of Title 22 and Health and Safety Code. Present today there were 2 unqualified teachers with 14 Prek children.
***California Code of Regulations, (Title 22, Div. 12, Ch 3), are being cited on the attached LIC 809D.

An exit interview was conducted. Appeal rights were given and explained to Director. Notice of site visit shall be posted for 30 days from today's visit.
This report is emailed to Director with a request for reply showing proof of receipt.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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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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: GOLDEN POPPY PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 214005487
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2021
Section Cited

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Qualifications & Duties:(d)An aide assisting a fully qualified teacher. . .shall meet the following requirements:(1) Completion of 6 semester/quarter units in early childhood education or child development.This requirement is not met as evidenced by:
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Based on observation, interview and record review facility did not ensure to have qualified staff in the classroom.This poses a potential health and safety risk to children in care.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2021
LIC809 (FAS) - (06/04)
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