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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000805
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:09:10 PM


Document Has Been Signed on 08/04/2023 12:09 PM - 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:FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THEFACILITY NUMBER:
384000805
ADMINISTRATOR:BECERRA, PATRICIAFACILITY TYPE:
850
ADDRESS:3101 MISSION STREETTELEPHONE:
(415) 550-4178
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:16CENSUS: 10DATE:
08/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Patricia Becerra, Flor CardenasTIME COMPLETED:
12:10 PM
NARRATIVE
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On 8/4/2023 at 8:45AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Lead Teacher, Flor Cardenas. Purpose of this report is to cite for deficiencies observed during unannounced, complaint inspection. Director, Patricia Bacerra arrived during inspection. Present was the Director and 2 staff caring for 10 children. LPA inspected facility for health and safety hazards.

At 10:30AM., Based on record review, interview and observations, LPA confirmed unqualified was staff, S2, was left alone with day-care children.



Based on today’s inspection, deficiencies were observed in areas evacuated according to the Title 22, Division 12, Chap, 3 of Ca, Code of Regulations and cited on the 809D. An exit interview, report, appeal rights, and plan of correction was discussed with the Director, Patricia Bacerra and signature of this form acknowledges the receipt of these documents.

A copy of this report and appeal rights were reviewed and provided to the director.
Notice of site visit was given and shall remain posted for 30 days.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
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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Document Has Been Signed on 08/04/2023 12:09 PM - 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: FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE
FACILITY NUMBER: 384000805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2023
Section Cited
CCR
101229(a)(1)

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101229 (a)(1) Responsible for Providing Care and Supervision. 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. This requirement was not met evidenced by:
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Director will review Aide / Teacher responsibilities with staff by the due date: 8/9/2023.

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At 10:30AM., Based on record review, interview and observations, LPA confirmed unqualified was staff, S2, was left alone with day-care children. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the department via email.

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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: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
LIC809 (FAS) - (06/04)
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