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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002455
Report Date: 12/03/2019
Date Signed: 12/04/2019 12:32:19 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:GROWING TREE SCHOOL LLC, THE (INF)FACILITY NUMBER:
384002455
ADMINISTRATOR:LUI, HOI YEEFACILITY TYPE:
830
ADDRESS:1984 GREAT HIGHWAYTELEPHONE:
(415) 682-8889
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:28CENSUS: 17DATE:
12/03/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Maggie PoonTIME COMPLETED:
05:30 PM
NARRATIVE
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LPAs conducted a case management inspection today. During the inspection, LPAs observed some staff members do not have fingerprint association/clearance. A civil penalty of $200 is issued today.

In addition, the facility's floor plan does not reflect the original floor plan submitted to CCL dated 10-25-2013. The facility needs to submit a new facility's sketch by 12-13-2019. A new fire clearance may be ordered.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: GROWING TREE SCHOOL LLC, THE (INF)
FACILITY NUMBER: 384002455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/04/2019
Section Cited

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101170(e)(1): Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department.
This requirement is not met as evidenced by:
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Based on a review of staff files and observation, S1 and S5 do not have Criminal Record Clearance. Licensee failed to ensure staff has criminal record clearance prior to working in the facility, which poses an immediate health and safety risk to children in care.
CIVIL PENALTY OF $200 ASSESSED
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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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2