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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504444
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:59:57 PM


Document Has Been Signed on 02/15/2023 12:59 PM - 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:SFUSD JOHN MCLAREN EARLY ED. SCHOOL (PRESCHOOL)FACILITY NUMBER:
380504444
ADMINISTRATOR:ANNA TOBINFACILITY TYPE:
850
ADDRESS:2055 SUNNYDALE AVENUETELEPHONE:
(415) 469-4519
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:96CENSUS: 38DATE:
02/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Maria OlivaresTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection today. Due to the principal was on leave, so LPA met with a Head Teacher, Maria Olivares and explained a purpose of the inspection to her. There were 38 children with 10 staff present. The facility submitted a self-report of an unusual incident that happened on 1/30/23. The incident related a staff pinched a child when a child was in care. Based on the interview and relevant documents CCL gathered, there was sufficient evidence to prove the incident had happened. Therefore, it was found to be SUBSTANTIATED.


See the next page of the deficiency that was issed under Title 22, Division 12 & Chapter 3




This report and notice of the site visit 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (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.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/15/2023 12:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 JOHN MCLAREN EARLY ED. SCHOOL (PRESCHOOL)
FACILITY NUMBER: 380504444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2023
Section Cited

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102423 (a)(4) Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (4) 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 eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
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The licensee must set up a plan of correction to prevent the same or similar incident from happening in the facility.
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 This requirement was not met as evidence-based upon interview and relevant docuement gathered by CCL, a staff pinched a child when the child was in care.

This poses a potential health risk to children in care.
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The licensee also shall hold a general meeting with the staff to discuss the personal rights policy and procedures. A copy of the meeting and a plan of correction shall be sent to LPA for deficiency clearance by 2/22/23.

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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (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
LIC809 (FAS) - (06/04)
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