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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001492
Report Date: 05/22/2019
Date Signed: 05/22/2019 12:19:49 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:LETTERMAN DIGITAL ARTS CCC (INFANT)FACILITY NUMBER:
384001492
ADMINISTRATOR:TROIA, KATHARINEFACILITY TYPE:
830
ADDRESS:ONE LETTERMAN DRIVE, BLDG. BTELEPHONE:
(415) 746-5444
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94129
CAPACITY:40CENSUS: 33DATE:
05/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Chona Roberto-ChengTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Singh and Van met with new director, Chona Roberto-Cheng, for the case management inspection for an incident. Purpose of the inspection was explained.

The facility self reported that on May 1, 2019, a child was left unsupervised within the facility. During today’s inspection, LPAs interviewed the director about the incident. Per director, director was not present at the time of incident. Per director, on above mention day, at 5:30 PM, two teachers and one aid were bringing a group of six children from play yard into the classroom. Per teacher, during the time of transition, a family was leaving from the facility after picking up their child and one of the day care child followed the family toward the outside. Per director, the child was observed by the security guard and was brought back into the classroom. Per director, the family of the child was informed, and all teachers were retrained.

During the inspection, it was observed that a child was left unsupervised by teacher for a short time. See next page for deficiencies cited today. Copy of this report is reviewed by and provided to director. Notice of site visit is posted and shall remain posted for next 30 days.

A Type “A” violation (see continuation) was issued today. The center is informed to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report and appeal rights were provided and reviewed with the licensee. Notice of Site Visit shall remain posted for 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)
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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: LETTERMAN DIGITAL ARTS CCC (INFANT)
FACILITY NUMBER: 384001492
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2019
Section Cited
CCR
101229(a)(1)
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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.
See below
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The facility has done the retraining for all of the present staff.
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This requirement is not met as evidenced by it was found that a child was separated from the group and teacher and was found by security guard. This poses an immediate 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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