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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380504229
Report Date: 10/29/2019
Date Signed: 10/29/2019 11:43:47 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2019 and conducted by Evaluator Winnie Ly
COMPLAINT CONTROL NUMBER: 05-CC-20190827143149
FACILITY NAME:FRIENDS OF ST. FRANCIS CHILDCARE CENTER, INC.FACILITY NUMBER:
380504229
ADMINISTRATOR:LARGE, SARAHFACILITY TYPE:
850
ADDRESS:50 BELCHER STREETTELEPHONE:
(415) 861-1818
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY:38CENSUS: 32DATE:
10/29/2019
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Sarah LargeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff pinched day care child.
INVESTIGATION FINDINGS:
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On October 29, 2019, at approximately 8:55am, Licensing Program Analyst (LPA) Winnie Ly arrived at the facility unannounced and met with Director Sarah Large. The purpose of this visit was to deliver the finding of this complaint investigation and was explained to the Director. Present at the facility were the Director, 6 teachers, a Site Supervisor and 24 children.

Based on staff interviews and information collected during the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12 & Chapter 1) are being cited on the attached LIC 9099D.

CONTINUED>>>

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 05-CC-20190827143149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: FRIENDS OF ST. FRANCIS CHILDCARE CENTER, INC.
FACILITY NUMBER: 380504229
VISIT DATE: 10/29/2019
NARRATIVE
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Type A violation is issued today. Director is advised to provide a copy of the Evaluation Report and Type A deficiency cited to the parents and guardians of the children currently enrolled in care and to parents of newly enrolled children for the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's Files.

An Exit Interview was conducted, a Plan of Correction (POC) was reviewed and developed with Director. A copy of this report and Appeal Rights were discussed and left with the Director whose signature on this form confirm receipt of the documents. Notice of Site Visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20190827143149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: FRIENDS OF ST. FRANCIS CHILDCARE CENTER, INC.
FACILITY NUMBER: 380504229
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/12/2019
Section Cited
HSC
101223(a)(3)
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101223 Personal Rights:
(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. The requirement is not met as evidence by:

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Staff to be provided training & provide documents of training to CCL. Training to be completed by 11/12/2019.
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Based on interviews and information collected child was pinched by facility staff while running during nap time. This poses an immediate 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3