410500286-7-11-2019-05-CC-GLEG-BE6TN3-20190717145203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 410500286
Report Date: 07/11/2019
Date Signed: 07/11/2019 04:23:50 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
04/23/2019 and conducted by Evaluator Cindy Interiano

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20190423154412

FACILITY NAME:	HAPPY HALL SCHOOL		FACILITY NUMBER:	410500286
ADMINISTRATOR:	JOHNSON,MARY		FACILITY TYPE:	850
ADDRESS:	233 SANTA INEZ AVENUE		TELEPHONE:	(650) 583-7370
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	143	CENSUS:	DATE:	07/11/2019
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Program Director, Shelley (Michelle) Marquez		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Daycare child got stuck underneath the refrigerator with injury.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Cindy Interiano, met with Program Director, Shelley (Michelle) Marquez, for a subsequent complaint inspection to discuss the above allegation. Present in the facility is Program Director and 13 Staff supervising 78 PreK children.
During the course of the investigation, interviews were conducted with Program Director, Staff, Guardians, and children.
Based on information obtained, a child got stuck underneath a refrigerator and received an injury. Staff immediately administered first aid and Guardian was notified.
Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation of a child getting stuck underneath the refrigerator and receiving an injury is found to be SUBSTANTIATED.
***California Code of Regulations, (Title 22, Div. 12, Ch 3), are being cited on the attached LIC 9099D.
An exit interview was conducted. Appeal rights were given and explained to Program Director. A Notice of Site Visit was observed being posted during this inspection.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 05-CC-20190423154412

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: HAPPY HALL SCHOOL	FACILITY NUMBER: 410500286
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/11/2019 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223(a)(2) Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as	1 2 3 4 5 6 7	The maintenance staff has placed a protective covering to preventing anyone/anything from going underneath the refrigerator. Deficiency has been cleared.
	8 9 10 11 12 13 14	evidence based on interviews conducted with Staff in which a child received an injury after getting stuck underneath a refrigerator. This poses a potential safety hazard 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: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 3

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
04/23/2019 and conducted by Evaluator Cindy Interiano

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20190423154412

FACILITY NAME:	HAPPY HALL SCHOOL		FACILITY NUMBER:	410500286
ADMINISTRATOR:	JOHNSON,MARY		FACILITY TYPE:	850
ADDRESS:	233 SANTA INEZ AVENUE		TELEPHONE:	(650) 583-7370
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	143	CENSUS:	DATE:	07/11/2019
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Program Director, Shelley (Michelle) Marquez		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulted in several accidents with injury.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Cindy Interiano, met with Program Director, Shelley (Michelle) Marquez, for a subsequent complaint inspection to discuss the above allegation. Present in the facility is Program Director and 13 Staff supervising 78 PreK children.
During the course of the investigation, interviews were conducted with Program Director, Staff, Guardians, and children. Program Director and Staff state children are supervised at all times and maintain staff:child ratios. When additional support is needed, Program Director is contacted. When a child receives an injury, first aid is immediately administered and Guardian is advised of the incident/injury. When a child is doing something inappropriate or unsafe, then the child is assisted by a staff and/or child is redirected to participate in a different activity. All Staff support each other to make sure the children are safe.
Although the allegation of a child having several accidents with injury due to lack of supervision may have happen or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are found to be ‘Unsubstantiated.’
An exit interview was conducted. Appeal rights were given and explained to the Program Director. A Notice of Site Visit was posted during this inspection.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

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

LIC9099 (FAS) - (06/04)

Page: 2 of 3