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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504523
Report Date: 01/29/2020
Date Signed: 01/29/2020 12:16:08 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:KATHERINE MICHIELS SCHOOL (PRE-K)FACILITY NUMBER:
380504523
ADMINISTRATOR:ZELLERBACH, LAURA ROSEFACILITY TYPE:
850
ADDRESS:1335 GUERREROTELEPHONE:
(415) 821-1434
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:36CENSUS: 31DATE:
01/29/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Director, Yolanda AnchetaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst, (LPA) Luis J. Gomez met with director, Yolanda Ancheta. The purpose of today's inspection was explained and is in response to an incident that occurred on January 14, 2020. The incident involved a two-year-old child who was injured in the outdoor play yard, requiring immediate medical attention. Present today is the director and three staff supervising 31 children. LPA Gomez inspected facility with director for health and safety hazards.

At 9:35am on January 29, 2020, LPA Gomez inspected the outdoor play area #1 for health and safety hazards. LPA Gomez observed the outdoor play area is completely enclosed. Outdoor play area has a metal screen between the fencing bars for additional child protection.

At 9:40am on January 29, 2020, LPA Gomez interviewed the facility site Director. Director stated that during preschool's outdoor play time, (S1) was running with the wagon when the child’s thumb became caught in the protective screen, located between outdoor play area #1 and outdoor play area #2. Director stated (S1) attempted to release his thumb from the fence, which caused (S1's) thumb nail to detach. Director stated, that the teacher on site ( J1) responded to the incident, providing first aid to the child's injury. Director stated she notified the child's parents immediately, arriving to center within 15 minutes, and taking child to the hospital.

Director stated she will continue to emphasize to her staff to be prepared and react accordingly when injuries occur on the play yard. Director stated, On 1/18/2020, a protective barrier was installed on the edges of the child safety screen for added protection.

After meeting with meeting with director and inspection of the physical plant, it was determined that the incident was handled in an appropriate and timely manner.
Exit interview was conducted and a Notice of Site Visit was given.
>This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site visit was observed being posted. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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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