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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000275
Report Date: 11/08/2019
Date Signed: 11/08/2019 05:24:03 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:FAMILY CONNECTIONS CENTERS - SCHOOL AGEFACILITY NUMBER:
384000275
ADMINISTRATOR:FLEMING, MARYANNFACILITY TYPE:
840
ADDRESS:2565 SAN BRUNO AVENUETELEPHONE:
(415) 715-6746
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:74CENSUS: 49DATE:
11/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Leslie PangTIME COMPLETED:
05:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Faye Bremer conducted an unannounced Annual inspection. LPA met with Lead staff Leslie Pang and explained purpose of inspection. This program picks up school-aged children from nearby elementary school, E.R. Taylor, and walks the children to nearby Palega playground. There were 6 teachers present with 49 children, ranging from kindergarten to 5th grade.

LPA walked with Leslie Pang at 2:30pm to E.R. Taylor to pick up the school-aged children for the after-school care, Home Work Club. Teachers arrive at E.R. Taylor at 2:30pm. There were 5 teachers present at the school upon Lead staff and LPA's arrival. All 6 teachers wore bright yellow safety vests. The program left the school with the 49 children at approximately 3pm to the playground. Program has approved outdoor playground waiver. LPA observed the pick up and sign in procedure, and observed the walk to the playground. There are bathrooms, tables, water fountains available at this playground, along with the play structure. Upon arrival to the playground, children were asked to wash hands and drink water prior to snack. Snack consisted of pretzels and clementine oranges which were provided by the program. The children are brought back to the center by the teachers at approximately 4pm for program.

LPA returned to the facility and met with Tina Tam to continue inspection. LPA inspected the facility for health and safety hazards. Classrooms are clean and orderly, at a comfortable temperature and sufficient lighting. Cubbies and hooks were available for children to store their belongings. All furniture, learning materials and equipment are age appropriate. All toxins and harmful objects are kept inaccessible to children. There were 5 restrooms with 6 toilets, 1 urinal, and 5 sinks available for children. Staff bathrooms are located at the rear of the facility. Staff use attendance sheets to keep track of children. All Licensing required posters are posted. Fire/emergency drills are conducted and logged, last conducted 9/9/19. LPA obtained copy of Children's rosters during visit.

Continues on following LIC809C page.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: FAMILY CONNECTIONS CENTERS - SCHOOL AGE
FACILITY NUMBER: 384000275
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/12/2019
Section Cited

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Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department.
This requirement is not met as evidenced by:
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Based on review of staff files and observation, S2 and S6 do not have Criminal Record Clearance. Licensee failed to ensure staff have criminal record clearance prior to working in the facility, which poses an immediate health and safety risk to children in care.
CIVIL PENALTY OF $1000 ASSESSED.
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Written POC to be received in CCLD office BY 11/12/2019.

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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.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: FAMILY CONNECTIONS CENTERS - SCHOOL AGE
FACILITY NUMBER: 384000275
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2019
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion - On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
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Based on staff records review, staff do not have proof of completed Mandated reporter training. Licensee failed to ensure staff have completed mandated reporter training, which poses a potential health and safety risk.
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of the completed Mandated Reporter training to CCL.

POC to be received in CCLD office BY 11/15/2019

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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.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: FAMILY CONNECTIONS CENTERS - SCHOOL AGE
FACILITY NUMBER: 384000275
VISIT DATE: 11/08/2019
NARRATIVE
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Continued from previous page.

Children and Staff files were reviewed during visit. All children have all required assessments, agreements and signed forms in files. Staff S2 and S6 do not have Criminal Record clearances. All staff do not have mandated reporter training.

$1000 CIVIL PENALTY ASSESSED FOR CRIMINAL RECORD CLEARANCE.

Deficiencies cited today under California Code of Regulations, Title 22, Div 12, follows on LIC 809D.
Appeal Rights given.
Report reviewed and discussed with Tina Tam
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4