384002480-10-4-2021-05-CC-GLEG-C7RSLY-20211013135907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002480
Report Date: 10/04/2021
Date Signed: 10/04/2021 05:12:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/30/2021 and conducted by Evaluator April Cowan

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210730141939

FACILITY NAME:	LANGUAGE IN ACTION-JOSE CORONADO CLUBHOUSE (PS)		FACILITY NUMBER:	384002480
ADMINISTRATOR:	AMORY DONOHUE, FOUNDER		FACILITY TYPE:	850
ADDRESS:	2498 FOLSOM STREET		TELEPHONE:	(415) 606-1205
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	22	CENSUS: 11	DATE:	10/04/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Leeby Flores		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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9

Day care child was inappropriately sexually touched by another child in care.

INVESTIGATION FINDINGS:

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On October 4, 2021 at 3:30 PM, Licensing Program Analyst (LPA) Cowan met with site supervisor for a subsequent inspection. The purpose of the inspection is explained and LPA is granted entry into the facility. Present in the facility is site director, 2 staff, and 11 children.

During the course of investigation, LPA interviewed licensee, site director, staff, and parents. Staff states that they could tell that something had happened to child in care while the children played under the slide. Site director states that she has trained staff on supervising children making sure to keep all children in view. Based on LPA’s interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations is founded to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

This report, Appeal Rights, and Notice of Site Visit is given to site director. Notice of Site Visit is to be posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 05-CC-20210730141939

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LANGUAGE IN ACTION-JOSE CORONADO CLUBHOUSE (PS)	FACILITY NUMBER: 384002480
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/08/2021 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the 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). Supervision shall include visual observation. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Site director agrees to email LPA agenda notes from training already held for staff regarding supervision.This will be due by 10/8/21.
	8 9 10 11 12 13 14	Based on interview staff did not see what happed to child as children played under a slide. This poses a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

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