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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384000199
Report Date: 11/02/2022
Date Signed: 11/02/2022 12:35:24 PM

Substantiated


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
08/23/2022 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220823102135
FACILITY NAME:CHILDREN'S DAY SCHOOL, INC.FACILITY NUMBER:
384000199
ADMINISTRATOR:GREENE, ANTONETTE B.FACILITY TYPE:
850
ADDRESS:333 DOLORES STREETTELEPHONE:
(415) 861-5432
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:72CENSUS: 53DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Antonette GreeneTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility staff physically restrained day care child.
Facility staff inappropriately handled day care child.
INVESTIGATION FINDINGS:
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On 11/2/2022 at 9:20AM., Licensing Program Analysts (LPA) Luis J. Gomez Maria Olguin- Leon met with Director, Antonette Green. Purpose of the inspection was explained and was for unannounced; complaint investigation. Present was the director and 9 staff supervising 53 children. LPA inspected facility for health and safety hazards.

During inspection, LPA performed site observations and interviewed staff.

During the course of the investigation, site observations were conducted on 8/29/2022, 10/19/2022 and 11/2/2022 . A review of the facility records was also complete, which included the children’s files, staff files, children’s roster and parent handbook. LPA conducted interviews with director, staff and all involved parties.
(REFER TO 9099C FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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 3
Control Number 05-CC-20220823102135
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: CHILDREN'S DAY SCHOOL, INC.
FACILITY NUMBER: 384000199
VISIT DATE: 11/02/2022
NARRATIVE
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(PAGE 2)
Regarding the allegation of facility staff physically restrained day care child; Based on information collected, LPA confirmed, facility staff restrained day-care child for undisclosed period of time.

Regarding the allegation of facility staff inappropriately handled day care child; LPA confirmed, facility staff used an unapproved intervention on day-care child.

Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation(s) are found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) are being cited on attached 9099D. Appeal Rights were provided to the facility.

Type “A” violations were issued today. Facility is advised to provide a copy of the Evaluation Report and the Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all Children's files.



This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment and appeal were discussed.

Signed copy of this report was provided to the licensee.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20220823102135
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: CHILDREN'S DAY SCHOOL, INC.
FACILITY NUMBER: 384000199
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/11/2022
Section Cited
CCR
101223(a)(2)
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101223(a)(2)Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Director will conduct training with staff to review proper intervention strategies by the due date: 11/11/2022. Agenda and signed attendance will be submitted to the department via email.
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Based on information collected, LPA confirmed, facility staff used an unapproved physical intervention and restrain day-care child. This poses an immediate health and safety risk to children in care.
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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.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3