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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500303
Report Date: 05/24/2023
Date Signed: 05/24/2023 12:30:08 PM


Document Has Been Signed on 05/24/2023 12:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:HIGHLANDS CHRISTIAN SCHOOLSFACILITY NUMBER:
410500303
ADMINISTRATOR:CAMACHO, CRYSTALFACILITY TYPE:
850
ADDRESS:1900 MONTEREY DRIVETELEPHONE:
(650) 873-4090
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:300CENSUS: 80DATE:
05/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Crystal Camacho & Samaa SroujiTIME COMPLETED:
12:45 PM
NARRATIVE
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T1=Teacher 1; T2=Teacher 2; T3=Teacher 3; C1=Child 1.

On May 24, 2023 at approximately 10:35am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management inspection. LPA met with director, Crystal Camacho, and explained the purpose of the inspection. During visit, director toured LPA of preschool classrooms.

Program operates in the Toddler Unit, "KC5", "KC6", "KC7", "Lions", "Giraffes", "Bears" and "Lambs" classrooms. During visit, LPA also met with associate director, Samaa Srouji.

The case management visit is in regards to an unusual incident that occurred May 8, 2023. Director self-reported incident to department's desk duty line on the same day.

On May 8, 2023 at approximately 2:49pm, T1, T2 and 5 enrolled children exited the back door in the Toddler Unit classroom to walk to the outdoor playground. As the group walked in the outdoor area, an enrolled child was picked up from the group. T1 spoke with child's family during pick up time in the outdoor area, located next to the facility. T2 remained with the other 4 enrolled children in the same area.

One of the 4 children, C1, left the group T2 was supervising. C1 walked, alone and unsupervised, in the opposite direction from T2. C1 walked same route Toddler Unit classroom walked when originally exiting the classroom, towards the facility's open gate parking lot.

C1 did not walk in the parking lot. At approximately 2:51pm, C1 was found by T3, whom does not work in preschool classrooms. T3 brought C1 to facility's main office.
(Continue Report on Page 2...)
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HIGHLANDS CHRISTIAN SCHOOLS
FACILITY NUMBER: 410500303
VISIT DATE: 05/24/2023
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(Continued, Page 2...)
Per director, T2 informed T1 that C1 was not present with the group. T1 and T2 searched for C1 in the outdoor area. Per associate director, C1 was brought from facility's main office to preschool's office as T1 and T2 searched for C1. Director brought C1 back to group with T1 and T2.

C1 did not have any injuries. C1's parents were notified of incident on same date. C1 was left unattended for approximately 2 minutes. Per associate director, entire incident of C1 leaving group and returning to group was approximately 5 minutes. C1 has returned to facility as of 5/9/2023.

Director held a mandatory staff meeting, reinforcing the importance of supervision. Proof of meeting was submitted to department.

Based on interviews, record review and director self-reporting, a child walked away from classroom group, resulting in a child being left unattended, therefore an immediate civil penalty has been cited under H&S 1597.58(c)(2). Please refer to 809D for more information.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Quimbo informed director, Crystal Camacho, that this report dated May 24, 2023 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Quimbo informed the director to provide a copy of this licensing report dated May 24, 2023 that documents any Type A citation to parents/guardian of all children enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Copy of Appeal Rights were provided.

Exit interview conducted and report was reviewed with director, Crystal Camacho, and associate director, Samaa Srouji.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/24/2023 12:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: HIGHLANDS CHRISTIAN SCHOOLS
FACILITY NUMBER: 410500303

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2023
Section Cited
HSC
1597.58(c)(2)

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1597.58 Civil Penalties (c)(2) The department shall assess an immediate civil penalty...for any of the following serious violations...Absence of supervision, including, but not limited to, a child left unattended...
This requirement was not met as evidenced by:
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Director self reported incident to CCLD and C1's family. Dirctor held a staff meeting, reinforcing importance of children's supervision.
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Based on interviews, record review and director self reporting incident, a child was left unattended and unsupervised by staff for approximately 2 minutes.
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Office meeting to occur at a later date.

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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
LIC809 (FAS) - (06/04)
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