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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001263
Report Date: 01/19/2021
Date Signed: 01/20/2021 05:08:47 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:JCCSF HELEN DILLER FAMILY PRESCHOOLFACILITY NUMBER:
384001263
ADMINISTRATOR:CIANCI, KARLAFACILITY TYPE:
850
ADDRESS:3200 CALIFORNIA STREETTELEPHONE:
(415) 292-1291
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:175CENSUS: 122DATE:
01/19/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Karla CianciTIME COMPLETED:
04:00 PM
NARRATIVE
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LPA Mok conducted an unannounced virtual case management inspection via Zoom with the Site Director, Karla Cianci, today. LPA explained the inspection purpose to her. The case management regarded an unusual incident that was reported by the facility on 12/23/2020. The incident had happened to a child who belonged to JCCSF Loise & Claude Rosenberg Early Childhood Center - #380504700 on 12/22/2020.

Due to the Pandemic, JCCSF moved the children from Loise Claude Rosenberg's site to Helen Diller's site from August 20th through December 22nd because they didn't have enough staff to supervise the children, and both facilities belong to JCCSF. The facilities operated as two different schools in different spaces at Diller's site. The teachers from Loise Claude Rosenberg supervised the children from the same facility at Diller's site. On December 22th, 2020 around 11:55am, a child from Rosenberg was left unsupervised on the fenced roof playground alone for six minutes after the teacher did the headcount before leaving the roof playground for lunch. The child left the group and turned into the blind spot after being counted while the teachers focused on having the other two children who played at the play structure join the group. The teachers left the playground with the children without a recount. A maintenance team member finally discovered the child was playing basketball alone around 12:01pm. The facility took a quick response to form a meeting with all staff and teachers to correct the mistake with a Plan of Correction the next day.

As a result, the following Title 22 deficiency was being cited on the following page: See LIC 809D.

Reports citing Type A violations are to be provided to parents/guardians of children currently in 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. This report must be available in the facility for public review.
This report was provided to the facility via e-mail.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2021
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: JCCSF HELEN DILLER FAMILY PRESCHOOL
FACILITY NUMBER: 384001263
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/19/2021
Section Cited

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101229(a)(1) Responsibility 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.
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This requirement was not met as evidenced by the report. A child from Rosenberg was left unsupervised on the fenced roof playground alone for six minutes after the teacher did the headcount before leaving the roof playground for lunch. A maintenance team member discovered a child at the roof playground. This poses an immediate safety risk to children in care.
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This deficiency was cleared during the inspection.

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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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2021
LIC809 (FAS) - (06/04)
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