384001263-5-9-2019-05-CC-GLEG-BC727L-20190514170855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384001263
Report Date: 05/09/2019
Date Signed: 05/09/2019 12:48:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2019 and conducted by Evaluator Andrea Medlin

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20190220093846

FACILITY NAME:	JCCSF HELEN DILLER FAMILY PRESCHOOL		FACILITY NUMBER:	384001263
ADMINISTRATOR:	SANDRA OSBORNE		FACILITY TYPE:	850
ADDRESS:	3200 CALIFORNIA STREET		TELEPHONE:	(415) 292-1291
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	175	CENSUS:	DATE:	05/09/2019
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Karla Cianci		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff failed to provide adequate supervision to daycare children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Andrea Medlin met with director for this conclusionary complaint visit. Physical plant toured including inside and outside child care areas. Based on information gathered and obtained, there had been an incident on 2/14/19. A child (C1) was in their classroom and walked to another (empty) classroom to put something in his cubby. The child then proceeded to walk out of the empty classroom into the corridor (hallway) looking for a mailbox. The child was able to exit locked doors and ended up being found outside the preschool perimeters by a "ballet studio" inside the building. The studio is open to the public as well as used during designated times by the preschool children. A man found the child and brought him back to the classroom and teachers. Though child did not exit the building, the child was able to walk away from his classroom and out into a public area in the building unsupervised.

(Continued on next pages 9099-C and 9099-D)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2019 and conducted by Evaluator Andrea Medlin

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20190220093846

FACILITY NAME:	JCCSF HELEN DILLER FAMILY PRESCHOOL		FACILITY NUMBER:	384001263
ADMINISTRATOR:	SANDRA OSBORNE		FACILITY TYPE:	850
ADDRESS:	3200 CALIFORNIA STREET		TELEPHONE:	(415) 292-1291
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	175	CENSUS:	DATE:	05/09/2019
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Karla Cianci		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Child(ren) using bathroom without supervision
Child left outside unattended

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Andrea Medlin met with director for this conclusionary complaint visit. Physical plant toured including inside and outside child care areas. Based on interviews, visual observation of bathroom to classroom, it is unknown whether a child or children had been able to use the bathroom without staff supervision. In some classrooms, the bathrooms are postioned in such a manner that it's possible to have multiple views, i.e. outside area and inside the bathroom and classroom. Regarding an incident of a child (C1) was being left unsupervised outside, LPA obtained the following information. The child was last in line as children were transitionining to go back inside the classroom. Per staff, a head count is always conducted especially during transition time. The child somehow missed the door being open to go inside and the door closed resulting in child being outside. The door is glass and staff could see child through it and immediately opened the door. The child had not been unsupervised at any point.
(Continued on next page 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 05-CC-20190220093846

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 05/09/2019

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. This report is reviewed with director and a copy of this report must be made available for public review upon request. Notice of site visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 05-CC-20190220093846

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 05/09/2019

NARRATIVE

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Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above listed allegations are found to be substantiated.

The deficiency cited on the following page is in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1:

This report is reviewed with director and must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 05-CC-20190220093846

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/09/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/16/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time.	1 2 3 4 5 6 7	Director counseled the staff involved with a written warning. Also the following day of incident, the team had review training in regard to systems and procedures for supervision.
	8 9 10 11 12 13 14	This requirement is not met as evidence that on 2/14/19 a child (C1) was able to leave classroom unsupervised. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Director provided a written plan of correction during the visit which includes using an empty classroom that was previously being used as a thorough way to exit.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 5