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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002201
Report Date: 07/17/2023
Date Signed: 07/17/2023 12:50:03 PM


Document Has Been Signed on 07/17/2023 12:50 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:FACESSF - MASONIC PRESCHOOLFACILITY NUMBER:
384002201
ADMINISTRATOR:KAREN LAMFACILITY TYPE:
850
ADDRESS:1101 MASONIC AVENUETELEPHONE:
(415) 355-0210
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY:71CENSUS: 30DATE:
07/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Kim WongTIME COMPLETED:
01:00 PM
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On 7/17/23, Licensing Program Analyst (LPA) Garcia made an unannounced case management visit to the child day care facility listed above and met with Site supervisor Dr. La Rhonda Martin and director, Kim Wong. The case management visit is from a self reported incident that occurred on 6/26/2023. The facility had 30 children and 11 teachers in total on site.

On the day of the incident, room 3 was combined with room 1 due to having only 3 students and teacher absences. The total number of students in room 1 for that day was 12 and 3 teachers were present. The incident occurred when Conor Gilan and other children were with a teacher transitioning from bathroom breaks to nap time. The child finished using the bathroom and the teacher with him was standing by the doorway while supervising the other children in the bathroom when he went upstairs to his regular classroom (room 3) rather than room 1. The child was found by another teacher upstairs next to his regular classroom and was assisted back downstairs.

Per Dr. Martin, the facility has implemented a schedule for those classroom combination days where there'll always be an adult by the front desk to keep an eye of the area. The facility is also in the process of getting new railings and stair gates, and currently have a contractor on stand by to start the repairs. Per Dr. Martin, they also purchased a temporary gate for the stairway and will arrive and be installed this week. The facility's supervision protocols is that each child is always accompanied during transition periods from one place to another. Per Dr.Martin, there's also a seating area with books for the children while waiting to be assisted back to the classrooms. The facility provided immediate plan of action to prevent similar incidents happening in the future. The plan of correction and the image of the gate ordered was sent to LPA's email.

Technical Violation was given today under California Code of Regulations, Title 22, Division 12.

101229 Responsibility for Providing Care and Supervision

Exit interview was conducted and report was reviewed with Site Supervisor, Dr. La Rhonda Martin.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023
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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