<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506367
Report Date: 10/21/2024
Date Signed: 10/21/2024 11:11:20 AM


Document Has Been Signed on 10/21/2024 11:11 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:SFUSD-THERESA S. MAHLER (EES) PRESCHOOLFACILITY NUMBER:
380506367
ADMINISTRATOR:COOK, CAROLYNEFACILITY TYPE:
850
ADDRESS:990 CHURCH STREETTELEPHONE:
(415) 695-5871
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY:80CENSUS: DATE:
10/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Carolyne CookTIME COMPLETED:
11:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 21st, 2024 at approximately 10:00 AM, Licensing Program Analyst (LPA) Janet Gil arrived at the facility to conduct a Case Management - Incident inspection. LPA met with director, Carolyne Cook. The purpose of today's inspection was explained. Inspection is in response to an Unusual Incident Report that was self reported and received by the department on October 9th, 2024.

This facility is a title 5 program operating in the SFUSD Theresa Mahler Early Education School Site. All staff at the facility have caregiver background checks through the San Francisco Unified School District. Facility operates in Classrooms #1,2 and 3. Present during inspection included 43 enrolled children and 11 staff (including director and office staff). LPA inspected the classrooms indoors and the outdoor area.

The facility self reported an incident that occurred on October 8th, 2024 in classroom #1. The incident involved lack of supervision that resulted in a child being left unsupervised inside of the classroom. Per interview and record review of incident received, a child was left alone inside a classroom for approximately 30 minutes. Per director, the staff failed to the do headcount resulting in a child being left alone in the classroom napping while all three staff left to supervise other children for outdoor play time. Parent arrived at facility at 4:30 PM for pick up and child was unable to be located. Per Director, another classroom staff found the child and brought child outside with parent for pick up.

During today's inspection, LPA spoke with director about the immediate actions that were taken. Per conversation with director, the action plan has been modified to take disciplinary action. Staff in classrooms have or will receive formal reprimands. All three classrooms are also required to fill out provided daily count forms during all transition periods of the school day. LPA observed all three classrooms had filled out daily count forms at time of inspection with correct number of children written on each form. Per Director, the school districts Compliance Officer came in on 10/17/2024 and spoke to the staff about daily count forms for each classroom.

Continued on Page 2...
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SFUSD-THERESA S. MAHLER (EES) PRESCHOOL
FACILITY NUMBER: 380506367
VISIT DATE: 10/21/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2 Continued...

Due to reported violation, a Type B deficiency has been issued. Please see LIC 809D for more details.

Deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. An exit interview was conducted with Carolyne Cook.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/21/2024 11:11 AM - 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SFUSD-THERESA S. MAHLER (EES) PRESCHOOL
FACILITY NUMBER: 380506367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2024
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(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation."

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The action plan has been modified to take disciplinary action. Staff in classrooms have or will receive formal reprimands. All three classrooms are also now required to fill out provided daily count forms during all transition periods of the school day.
8
9
10
11
12
13
14
Based on interview and record review, the facility did not comply with the section cited above as facility self reported that there was a child left alone inside the classroom #1 during outdoor play, which poses an immediate health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet GilTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3