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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380504442
Report Date: 02/15/2023
Date Signed: 02/15/2023 10:30:48 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 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
01/06/2023 and conducted by Evaluator Winnie Ly
COMPLAINT CONTROL NUMBER: 05-CC-20230106155131
FACILITY NAME:SFUSD-NORIEGA EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
380504442
ADMINISTRATOR:NG, IVYFACILITY TYPE:
850
ADDRESS:1775 - 44TH AVENUETELEPHONE:
(415) 759-2853
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:136CENSUS: 85DATE:
02/15/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ivy NgTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff did not provide adequate supervision to day care children resulting in day care children engaging in inappropriate behavior.
INVESTIGATION FINDINGS:
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On February 15, 2023, Licensing Program Analysts (LPAs) Ly, arrived at the facility unannounced to close the complaint investigation the above allegation and met with Principal Ivy Ng. Facility also self reported incident to Child Care Licensing and Child Protective Services There were 85 children and 16 staff present during today's visit.

Based on investigation and information gathered through interviews, the allegation Staff did not provide adequate supervision to day care children resulting in day care children engaging in inappropriate behavior, the preponderance of evidence standards has been met, therefore, the above allegation is found to be SUBSTANTIATED. A Type “B” violation was issued today in accordance to the California Code of Regulations, Title 22, Division 12, Chapter 1, citation is being cited on the attached LIC9099D.

A Plan of Corrections (POC) was developed and reviewed with the Principal. A copy of this report and rights to comment and appeal have been discussed with the Principal. Notice of Site Visit shall remain posted for 30 days.
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: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 05-CC-20230106155131
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SFUSD-NORIEGA EARLY EDUCATION SCHOOL (PS)
FACILITY NUMBER: 380504442
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2023
Section Cited
CCR
101229
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101229 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:
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Principal will discuss with classroom teachers regarding childdren's supervision.
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Based on interviews of all parties involved.
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Principal will submit sign documentation regarding discussion to CCL by 02/27/2023.
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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: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
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