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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004339
Report Date: 12/15/2021
Date Signed: 12/15/2021 02:13:30 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:MISSION KIDSFACILITY NUMBER:
384004339
ADMINISTRATOR:MARCHIEL, CHRISTINA M.FACILITY TYPE:
850
ADDRESS:969 TREAT AVENUETELEPHONE:
(415) 970-9027
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:96CENSUS: 53DATE:
12/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Christina MarchielTIME COMPLETED:
02:30 PM
NARRATIVE
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On 12/15/2021 at 12:30P.M., Licensing Program Analyst (LPA), Luis J. Gomez met with licensee Christina Marchiel. Purpose of inspection was explained was for an unannounced subsequent Case Management inspection to issue deficiency based on finding from IB investigation. Present during inspection was the Licensee, and 13 staff supervising 53 children. LPA inspected facility with licensee for health and safety hazards.

Based on the information obtained by IB Investigation report, it was confirmed, facility staff member was present in day-care without proper facility association.

During inspection, a deficiency was cited according the Title 22 Division 12 of Ca. Code of Regulations and listed on the 809- D. An exit interview was conducted with licensee and plan of correction was discussed. A copy of this report with the appeal rights was provided, and signature of this form acknowledges the receipt of these documents.



Type “A” violation was issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

A civil penalty of $100 was assessed.

Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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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: MISSION KIDS
FACILITY NUMBER: 384004339
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
12/16/2021
Section Cited

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101170(e)(2) 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: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f): This requirment is not met as evidenced by:
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Based on IB Investigation report, it was confirmed, facility staff member was present in day-care without proper facility association. This poses an immediate health and safety risk to children in care.
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Proof of correction will be submitted to the Department via email.

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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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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