380505725-9-17-2021-05-CC-CINO-C7CT2V-20210930142124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 380505725
Report Date: 09/17/2021
Date Signed: 09/17/2021 10:53:09 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
08/02/2021 and conducted by Evaluator Catrina Quimbo

COMPLAINT CONTROL NUMBER: 05-CC-20210802120153

FACILITY NAME:	ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT		FACILITY NUMBER:	380505725
ADMINISTRATOR:	TUWAI, KATHY		FACILITY TYPE:	830
ADDRESS:	5200 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 550-1536
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	39	CENSUS: 21	DATE:	09/17/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Director, Kathy Tuwai		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff member tested positive for Covid.

Facility not providing safe sleep to children in care.

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

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-20210802120153

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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 09/17/2021

NARRATIVE

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(Continued, Page 2)

During course of investigation, director and all infant staff members interviewed stated that at least one enrolled infant who sleeps in a crib at facility used a loose object and/or toy while in the crib on more than one occasion. Facility did not provide safe sleep to at least one child in care.

Based on LPA’s interviews and record review which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, are being cited. Please refer to 9099D for more information.

After today’s visit, an exit interview was conducted with director, Kathy Tuwai. Upon receipt of this report, director shall post the Notice of Site Visit. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public ad can be reviewed.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 05-CC-20210802120153

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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/04/2021 Section Cited CCR 101439.1(f)	1 2 3 4 5 6 7	101439.1 Infant Care Center Sleeping Equipment (f)…Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director stated all staff will be trained on updated safe sleep regulations. Director to provide staff training with written documentation form. Evidence of this written documentation will be submitted to LPA no later than 10/04/2021 by 5:00pm.
	8 9 10 11 12 13 14	Based on observations, interviews and record review, the staff members of facility allowed an enrolled infant to use a loose object while sleeping in the crib. This poses a potential health, safety or personal rights risk to children in care.	8 9 10 11 12 13 14
Type B 09/17/2021 Section Cited CCR 101212(d)(1)(C)	1 2 3 4 5 6 7	101212 Reporting Requirements (d)(1)(C) … during the operation of the child care center…a report shall be made to the Department…within the Department’s next working day and during its normal business hours…Events reported shall include…any unusual incident…that threatens the…health or safety of any child. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Unusual Incident Report (LIC624) signed off by director, was submitted to LPA via email on 08/5/2021. LPA has followed up on positive COVID case. Staff member who tested positive has completed 14 day quarantine and returned to facility 08/15/2021. Deficiency cleared during complaint visit on 09/17/2021.
	8 9 10 11 12 13 14	Based on observations, interviews and record review, facility’s staff member had tested positive. Facility failed to report incident to Department within Department’s next working day during its normal business hours. This poses a potential health, safety or personal rights risk to children in care.	8 9 10 11 12 13 14

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: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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
08/02/2021 and conducted by Evaluator Catrina Quimbo

COMPLAINT CONTROL NUMBER: 05-CC-20210802120153

FACILITY NAME:	ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT		FACILITY NUMBER:	380505725
ADMINISTRATOR:	TUWAI, KATHY		FACILITY TYPE:	830
ADDRESS:	5200 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 550-1536
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	39	CENSUS: 21	DATE:	09/17/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Director, Kathy Tuwai		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility operating out of ratio.

INVESTIGATION FINDINGS:

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On September 17, 2021 at 9:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, complaint investigation to St. Nicholas Day Care and Prechool-Infant. LPA met with director, Kathy Tuwai. The purpose of the visit was explained to director.

Present at facility are 5 staff members/teachers (including director) and 15 infants. During the investigation, LPA conducted classroom observations, interviews, and reviewed records and documents. As part of this complaint investigation, interviews were conducted with the director, 5 infant staff members and random selection of enrolled infants’ parents.

Majority of staff members interviewed stated facility’s ratio operates 1 staff member to 4 enrolled infants. Majority of staff members interviewed stated facility does not operate over ratio. Upon LPA’s classroom observations, classroom was adequately staffed and within facility’s operating ratio.

Although the above allegation may have happened or is valid, based on LPA’s interviews and record review which were conducted, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

After today’s visit, an exit interview was conducted with director, Kathy Tuwai. Upon receipt of this report, director shall post the Notice of Site Visit. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4