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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004017
Report Date: 07/18/2019
Date Signed: 07/18/2019 04:27:55 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:TINKER PRESCHOOL COLE VALLEYFACILITY NUMBER:
384004017
ADMINISTRATOR:ANNIE LIMFACILITY TYPE:
850
ADDRESS:1749 WALLER STREETTELEPHONE:
(415) 425-3248
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY:42CENSUS: 26DATE:
07/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Wendy WehTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Cindy Mok and Faye Bremer conducted an unannounced Case Management inspection in response to an incident that occurred at the facility on June 14, 2019, which was reported to CCL on June 17, 2019. LPAs met with Site Supervisor Wendy Weh and explained purpose of inspection. Based on incident report, C1 had consumed eggs and had an allergic reaction. S1 had provided C1 with the food. C1 required an epi pen to be administered, and 911 was called. Based on report and interview with Site Supervisor, S1 no longer works at this facility. LPAs requested to review files for C1 and for S1.

LPAs toured and inspected the center, and observed the center to have general cleanliness throughout. The children in the classrooms were napping upon LPAs arrival. There were 9 children in the Mullberry classroom (Toddler Room), 11 children in the Laurel A classroom, 8 Laurel B classroom, and 6 in the Oak classroom. There were 8 staff present today.

Based on information gathered during today's inspection through records review and interview with Site Supervisor, it was found that the facility was made aware upon admission that C1 has an allergy to eggs. Facility has documentation in the children's files as well in the kitchen of the children who have food allergies, but does not have documentation of allergies in the children's classrooms for the teachers review.

* See next page of the deficiency that was cited during the inspection today.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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: TINKER PRESCHOOL COLE VALLEY
FACILITY NUMBER: 384004017
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2019
Section Cited
CCR
101223(a)(2)
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101223(a)(2) Personal Rights

To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by based upon interview and documentation.
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Licensee shall provide a Plan of Correction to ensure all facility staff have a training on how to meet the needs of children with allegies Licensee shall provide a copy of the plan to Child Care Licensing by 7/19/19. The POC shall include date of the training, and copy of the sign in/out when the training is completed.
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*C1 had consumed eggs and had an allergic reaction. S1 had provided C1 with the food. C1 required an epi pen to be administered, and 911 was called.

This poses an immediate safety risk to children in care.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
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