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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000669
Report Date: 02/21/2020
Date Signed: 02/21/2020 09:43:37 AM

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:SFUSD-DOLORES HUERTA ELEMENTARY SCHOOL (EES)FACILITY NUMBER:
384000669
ADMINISTRATOR:RODRIGUEZ, LUISFACILITY TYPE:
850
ADDRESS:65 CHENERY STREETTELEPHONE:
(415) 695-5669
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:24CENSUS: 13DATE:
02/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Luis RodriguesTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Van conducted an announced case management inspection today and met with the Principal, Luis Rodriguez, in response to an unusual incident self-reported to licensing on Feb 11, 2020. The incident involved C1, who was left behind and unattended during a transition time. A third-grade teacher found C1 by the classroom door, and the teacher brought C1 back to C1’s classroom.

During today's inspection, LPA evaluated the physical space where the incident occurred, as well as care and supervision, which is provided by the teachers. LPA interviewed the paraprofessional who was involved and had direct knowledge of the incident. Based on the statements from a paraprofessional, it was determined that a lack of care and supervision had occurred on Feb 5, 2020, C1 was left without supervision for 5 minutes.

Following the incident, Management responded immediately to the occurrence of this incident. A mandatory staff meeting was conducted, and the agenda included Attendance Protocols and Supervision policies and procedures. Staff involved in the incident received additional training, and new protocols have been followed. The substitute teacher was made aware of the transition procedure prior to starting the shift. Teachers will conduct a headcount during transitions, before or after arrival or leaving any area. Also, children will line up, be counted and one teacher will be positioned at the front and back of the line, and confirmation between the two teachers is required.

As a result, the following Title 22 deficiency is being cited on the following page. An exit interview was conducted; Plans of corrections were reviewed and developed with the Director. Appeal Rights were provided and discussed with the Director. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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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: SFUSD-DOLORES HUERTA ELEMENTARY SCHOOL (EES)
FACILITY NUMBER: 384000669
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2020
Section Cited

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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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).Supervision shall include visual observation.
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This requirement is not met as evidenced by confirmation that a lack of supervision had occurred on Feb 05, 2020, where a child was not accounted for 5 minutes and was found by another teacher, and brought back to the child’s classroom, this poses an immediate health and safety risk to the child 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.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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