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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002202
Report Date: 10/10/2023
Date Signed: 10/10/2023 01:45:29 PM


Document Has Been Signed on 10/10/2023 01:45 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 - HAYES VALLEY CDC (INFANT)FACILITY NUMBER:
384002202
ADMINISTRATOR:KIMBERLY WONGFACILITY TYPE:
830
ADDRESS:305 BUCHANAN STREETTELEPHONE:
(415) 552-1535
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:18CENSUS: 16DATE:
10/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Stephanie KuyperTIME COMPLETED:
01:45 PM
NARRATIVE
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On October 10, 2023, Licensing Program Analyst (LPA) Van conducted an unannounced Case Management inspection and met with the new Site Director, Stephanie Kuyper. The purpose of the inspection was to follow up on an unusual incident and discuss preventive measures to ensure the safety and well-being of all children attending the facility. This is an infant and toddler component Center that is licensed for a total capacity of 18, with no more than 12 toddlers and 6 infants. Today, there are 10 toddlers and 6 infants supervised by six staff and the Site Supervisor. The facility self-reported an incident on October 3, 2023, involving a child (C1) who was left unattended and later found in the fenced-off area of the play yard. It was believed that the child wandered off by following another staff member who was off the clock.

Based on the interview and the incident report received on September 20, 2023, regarding the above incident, it was found that supervision was absent when the child was left in the play yard unattended and without the teacher's knowledge. A Type "A" violation was issued today. The Facility is advised to provide a copy of the Evaluation Report and the Type "A" Deficiency cited to the parents and guardians of children currently enrolled and 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 will be maintained in the facility file and made available for public review three years after the thirty-day posting requirement has been met. Today's report, October 10, 2023, appeal rights, and notice of the site were provided to the Director. LPA informed the Head of the school that the site visit notice and deficiency page must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
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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Document Has Been Signed on 10/10/2023 01:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 - HAYES VALLEY CDC (INFANT)
FACILITY NUMBER: 384002202

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision...children's needs. (1) 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).
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Following an incident that occurred, the director met individually with the staff members who were involved. Additionally, the involved staff members were reprimanded for their actions. The director has made plans to conduct an Active Supervision training course, and all the training materials, along with the sign-in attendance of the staff members, will be submitted to the Licensing office no later than October 11, 2023.


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This requirement is not met, as evidenced by the interview and facility incident report. The staff failed to provide adequate supervision, which allowed C1 to leave the classroom without the staff's knowledge and was found alone in the play yard. This poses an immediate health and safety risk to children in care.
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A possible follow-up Informal Meeting is to be scheduled for a later date.

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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) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
LIC809 (FAS) - (06/04)
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