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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500254
Report Date: 02/10/2023
Date Signed: 02/10/2023 10:58:39 AM

Document Has Been Signed on 02/10/2023 10:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:HAIGHT ASHBURY COOPERATIVE NURSERY SCHOOLFACILITY NUMBER:
380500254
ADMINISTRATOR:DRAKE, COCOAFACILITY TYPE:
850
ADDRESS:1180 STANYAN STREETTELEPHONE:
(415) 661-9204
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 2DATE:
02/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Cocoa DrakeTIME COMPLETED:
12:00 PM
NARRATIVE
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On 2/10/23, Licensing Program Analyst (LPA), Garcia made an unannounced visit to the Haight Ashbury Cooperative Nursery School facility to deliver the findings and close out a complaint in conjuction with annual inspection. LPA was granted entry by the director, Cocoa Drake. LPA explained the purpose of the visit to the licensee. All the facility's staff members have had their criminal background checks cleared by Guardian. Upon arrival, there were 2 preschool children and 3 parent volunteers working for the day.

During the LPA’s investigation, interviews, and record review which were conducted, the preponderance of evidence standard has been met, that the facility did not report an incident resulting in a child becoming lost. Please refer to 9099D for more information.

The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.

An exit interview was conducted with Licensee, Cocoa Drake. A copy of this report was reviewed and provided to licensee.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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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Document Has Been Signed on 02/10/2023 10:58 AM - It Cannot Be Edited


Created By: Nathan Garcia On 02/10/2023 at 10:19 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: HAIGHT ASHBURY COOPERATIVE NURSERY SCHOOL
FACILITY NUMBER: 380500254

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2023
Section Cited
CCR
101212(d)

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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
This requirement is not met as evidenced by:
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Director will provide written plan of action and protocols if such incidents occur.
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During the course of the investigation, LPA conducted interviews with director and other people involved that the inicdent that occured on 11/4/22 resulting in a child becoming lost was not reported to Licensing Department.
This poses a potential health and safety risk to children in care.
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Director will send copy to LPA by set due date, 3/10/23.

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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023


LIC809 (FAS) - (06/04)
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