380504942-3-19-2025-05-CC-MROZ-DG7VF3-20250429162311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 380504942
Report Date: 03/19/2025
Date Signed: 03/19/2025 03:42:25 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
03/14/2025 and conducted by Evaluator Catrina Quimbo

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20250314154015

FACILITY NAME:	ASSOCIATED STUDENTS CHILDREN'S CENTER - PRESCHOOL		FACILITY NUMBER:	380504942
ADMINISTRATOR:	ALMAGUER, ERICA		FACILITY TYPE:	850
ADDRESS:	1650 HOLLOWAY AVENUE		TELEPHONE:	(415) 338-2403
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY:	60	CENSUS: 31	DATE:	03/19/2025
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Lorelei Ballesteros		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not ensure adequate care and supervision is being provided to children in care.

INVESTIGATION FINDINGS:

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C1=Child 1, S1=Staff 1, S2=Staff 2, S3=Staff 3, A1=Adult 1.

On March 19, 2025 at approximately 10:50am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, complaint visit. LPA met with assistant director, Lorelei Ballesteros, and explained the purpose of the visit.

Facility is a combination center of a preschool and infant license. Preschool program is licensed to operate in Classrooms #6-9. During today’s visit, preschool program is operating in: Room 6-Orange Room (Transitional Twos), Room 7-Blue Room (3-5 year olds) and Room 8-Red Room (3-5 year olds). Under preschool license, present during today's visit included 31 preschool children and 10 teaching staff. Under the infant license, present during today's visit included 37 infants and 12 teaching staff.

On March 14, 2025 at approximately 11:00am, S1, S2 and S3 were in the enclosed, outdoor play area with 11 children. S1 and S2 were facing the playground, with their backs against the fence. S3 was walking children towards the red classroom for water.

A1 was on the roof of the facility while children remained in the enclosed play area. From the roof, A1 observed C1 on the outside of the enclosed fence, outside of the program’s premise. A1 informed staff that C1 had exited the enclosed outdoor play area.
(Continue Report on 9099C...)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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 4

Control Number 05-CC-20250314154015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ASSOCIATED STUDENTS CHILDREN'S CENTER - PRESCHOOL	FACILITY NUMBER: 380504942
	VISIT DATE: 03/19/2025

NARRATIVE

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(Continued, Page 2...)
S1 observed the gate C1 exited the play area from, to be ajar. S1 observed C1 run from the outdoor play area, away from the facility premise, towards a neighboring building. S1 obtained and returned C1 to the enclosed, outdoor play area. C1 did not obtain any injuries. Incident lasted for approximately 1-2 minutes, starting from the time C1 exited play area and C1 returning to play area.

Director, preschool assistant director and infant assistant director were informed of incident. Authorized representative of C1 and department were also informed of incident on the same date. Enrolled children have been reminded doors are for adult use only. As of this date, C1 has not returned to facility.

During today’s visit, LPA conducted classroom observations, outdoor play area observations, obtained documents and interviewed random selection of staff. An enrolled child was able to exit facility premise without the supervision of teaching staff.

Based on director self-reporting incident and interviews conducted, 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, are being cited. Please refer to 9099D for more information.

Program is being cited a Type A citation for absence of supervision. Civil penalty was assessed due to repeat violation within 12 months.

LPA Quimbo informed facility representative, Lorelei Ballesteros, that this report dated March 19, 2025 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Quimbo informed the facility representative to provide a copy of this licensing report dated March 19, 2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal rights were provided during visit. A plan of correction was also discussed.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Lorelei Ballesteros

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 05-CC-20250314154015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ASSOCIATED STUDENTS CHILDREN'S CENTER - PRESCHOOL	FACILITY NUMBER: 380504942
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/19/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/20/2025 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	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…shall be left without the supervision of a teacher… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Civil penalty assessed due to a repeat violation within 12 months. Office meeting may occur.
	8 9 10 11 12 13 14	Based on interviews and record review, a child was able to exit facility premise without the supervision of staff. This poses an immediate health, safety and personal rights risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC9099 (FAS) - (06/04)

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