<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410501367
Report Date: 08/22/2019
Date Signed: 08/22/2019 02:24:15 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:STEPPING STONEFACILITY NUMBER:
410501367
ADMINISTRATOR:THOMAS, TERESAFACILITY TYPE:
850
ADDRESS:1421 PALM DRIVETELEPHONE:
(650) 343-3362
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:33CENSUS: DATE:
08/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Teresa ThomasTIME COMPLETED:
02:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Case Management visit to follow up on an incident reported to CCLD office by phone on 8/14/19. LPA met with Director Teresa Thomas and explained purpose of visit. Director provided LPA with a copy of incident report mailed to CCLD office. Per incident report received, Staff S1 witnessed child (C1) with child's parent (P1) in the bathroom together with P1 taking pictures of C1 while P1's other child (C2) was blocking the doorway of the bathroom.

LPA toured the physical plant, conducted interviews with staff, and reviewed C1's record. LPA was unable to interview C1 today. Based on interviews conducted, S1 informed Director immediately of what was witnessed between parent and child. S1 was trying to pick up belongings inside of facility due to end of shift when incident was witnessed. All other staff and children present were outside in the play yard at the time of the incident. Director came inside the facility to check on C1 and P1. Director spoke to P1 but P1 made no mention of what was witnessed. Director also informed P2 about the incident.

No deficiencies were cited today. The facility reported the incident to CCLD promptly. A follow up visit may be required at a later date.

This report was reviewed and discussed with Director Teresa Thomas. A copy of the report was provided.

This report must be available in the facility for public review. Notice of site visit was posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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 1