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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384001263
Report Date: 07/26/2024
Date Signed: 07/26/2024 09:51:21 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
05/10/2024 and conducted by Evaluator Man Tso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240510140321
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: 22DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Assistant Director, Karyn KhanTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Staff did not notify child's authorized representative of incident
Staff did not prevent daycare child from being harmed by another child to
Staff did not provide a safe and comfortable environment for daycare children
INVESTIGATION FINDINGS:
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On July 26, 2024, at approximately 8.35am, Licensing Program Analyst (LPA) Tso conducted a visit for delivery of the complaint investigation findings and met with the Assistant Director, Karyn Khan. Present during the inspection was the Assistant Director, 11 teachers, caring for 22 children.

Based on LPA’s gathered information through observation, interviews and records reviews, the agency has investigated the complaint allegations above. The facility did not comply with the parental rights and personal rights regulations. The facility did not inform the parent whose child was hit, and the staff did not prevent hitting a child by other child. The preponderance of evidence standard has been met. The above allegations are found to be SUBSTANTIATED. Two Type B violations were issued today, July 26, 2024 in accordance with the California Code of Regulations, Title 22, Division 12 & Chapter 3, citations were being cited on the attached LIC 9099Ds.

Exit interview conducted and a copy of this report and appeal rights were discussed and left with the Assistant Director, Karyn Khan, whose signature on this form confirms receipt of these reports. Notice of Site Visit (The Notice) was provided. The Notice to remain posted for 30 days.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man TsoTELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 2
Control Number 05-CC-20240510140321
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JCCSF HELEN DILLER FAMILY PRESCHOOL
FACILITY NUMBER: 384001263
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
08/16/2024
Section Cited
CCR
101218.1(a)(2)(B)
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Admission Procedures and Parental and Authorized Representative's Rights (a) In accordance with the child care center's individual program, policies and needs, the licensee shall develop, implement and maintain an admission procedure that enables the person in charge of admissions to: (2) Conduct one or more personal interviews with the child's parent or authorized representative that meets the following requirements:
(B) Provides the child's parent or authorized representative with information about the child care center that shall at least include the child care center's admission policies and procedures, activities, services, regulations, hours and days of operation, fees, procedures to be followed should the child become ill or injured while at the child care center, and procedures for conducting inspections for illness.

This requirement is not met as evidenced by:
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The Director should train the staff to ensure the Parental and Authorized Representative's Rights. Email LPA agenda and a signature of all in attendance by 8/16/2024.
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Based on observation and interviews, the facility did not comply with the section cited above for not informing the parent whose child was hit, which poses a potential health, safety, or personal rights risk to persons in care.
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Request Denied
Type B
08/16/2024
Section Cited
CCR
101223(a)(2)
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Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
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The Assistant Director should train the staff to ensure the Personal Rights. Email LPA agenda and a signature of all in attendance by 8/16/2024.
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Based on observation and interviews, the facility did not comply with the section cited above for not prevent the child in care to be harmed by other child that does not provide the safe environment to the children in care, which pose a potential health, safety, or personal rights risk to persons 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: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man TsoTELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
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