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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001721
Report Date: 12/18/2023
Date Signed: 12/18/2023 04:10:32 PM


Document Has Been Signed on 12/18/2023 04:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SFCCD-MISSION COMMUNITY COLLEGE CENTERFACILITY NUMBER:
384001721
ADMINISTRATOR:MARIA VILLASANAFACILITY TYPE:
850
ADDRESS:1125 VALENCIA STREETTELEPHONE:
(415) 920-6200
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:40CENSUS: 10DATE:
12/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Melissa SeranoTIME COMPLETED:
04:15 PM
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On 12/18/2023 at 1:00PM. Licensing Program Analyst, (LPA) Luis J. Gomez met with Teacher, Marta Juarez. The purpose of today's inspection was explained and was in response to an unusual incident report submitted to the Department on 11/1/2023. Director, Melissa Serano arrived during inspection. Present was Director and two staff supervising 10 children. Children present had been properly signed in. LPA inspected facility for health and safety hazards.

During the inspection, LPA performed observations, record review, and interviews.

Per incident report, child in program, C1, reported they had been hit, and had their hair pulled by staff member, S1, while in care. Per director, incident initiated a subsequent investigation and a parent-teacher conference was held. Per director, staff S1 has continuously denied the allegations made. Per director, staff are reminded to adapt their supervision to each child's specific need.

Based on information collected, LPA confirmed inappropriate restraining was used on child while in care. Advisory Note: Technical Violation (LIC9102TV) was issued to facility.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Chapt. 1. ***

This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site inspection was posted. Any additional questions to call Office, M-F, 8a-5p, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
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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