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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001263
Report Date: 11/04/2019
Date Signed: 11/04/2019 12:05:28 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: DATE:
11/04/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Karla CianciTIME COMPLETED:
12:15 PM
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On November 04, 2019, at approximately 11:20am, Licensing Program Analyst conducted an Unannounced Case Management inspection and met with Site Director Karla Cianci. Purpose of visit was explained to Director. Present during the visit were Site Director, 37 staff and 160 children. A self reported incident was received by our Department on 10/23/2019 regarding an incident that occurred on 10/18/2019. According to the unusual incident report, the incident involved a child touching the conduit that was attached to the exit sign for the playground up in the roof. The child received a shock and immediately pull his hand away. When the child was examined by the JCC Security EMT, there was some redness shown on his hand.

On this day, LPA inspected the conduit. LPA shook the conduit and it seemed to be stabled. Per Director, parent was notified that day and advised to seek medical attention but parent chose not to. The incident happened on Friday and the child came back to school on the following Monday. Director also stated that, the playground was closed immediately after the incident. Older Children had gone to the nearby parks for outdoor play during that period while playground was closed for electrician to inspect and fix the conduit. The younger group of children used the playground on the second floor which is not connected to the one on the roof; therefore, it was determined to be safe.

On this day, LPA collected an invoice as a proof that the facility had an electrical company named Muscio Electric to repair the conduit.

No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2019
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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