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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000892
Report Date: 05/22/2019
Date Signed: 05/22/2019 10:26:08 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-TENDERLOIN COMMUNITY EARLY EDUCATION SCHOOLFACILITY NUMBER:
384000892
ADMINISTRATOR:BERMAN, BARBARAFACILITY TYPE:
850
ADDRESS:627 TURK STREETTELEPHONE:
(415) 614-3000
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:30CENSUS: 22DATE:
05/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Emily Gill & John Collins TIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) met with teacher, Emily Gill, and vice principal, John Collins, for a case management inspection for an incident. Purpose of the inspection was explained.

The facility self report an incident which occurred on April 24, 2019. During today’s inspection, LPAs interviewed the teacher, Emily Gill. Per Emily, on above mentioned date, children were playing in the play yard. Per teacher, two children were playing, and one child pulled the other child by holding the child from shirt. Per teacher, a staff member observed the incident and pulled the child from child’s shirt and asked the child how it feels. Per teacher, the incident was brought to the management’s attention and parent was notified. Per teacher, the child did not have any injury or marks. Per teacher, the staff member is no longer working with the children, but only working in the office. Per teacher, facility conducted the meetings and training with staff members and explained the positive behavior policy.

During the inspection it was observed that the child’s personal rights were violated. See next page for deficiencies cited today. Copy of this report is reviewed by and provided to vice principal. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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 2
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-TENDERLOIN COMMUNITY EARLY EDUCATION SCHOOL
FACILITY NUMBER: 384000892
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2019
Section Cited
CCR
101223(a)(3)
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101223(a)(3) Personal Rights : The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature See below
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The facility has the staff member removed from the classroom. Facility has conducted the staff meetings and trainings.
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including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by facility reported that a child was pulled by the shirt by another shirt. This poses a potential 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.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
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