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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410503217
Report Date: 03/22/2022
Date Signed: 03/29/2022 04:13:07 PM

Substantiated


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
01/24/2022 and conducted by Evaluator Leslit Tapia-Mandujano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220124140009
FACILITY NAME:TRINITY PRESCHOOLFACILITY NUMBER:
410503217
ADMINISTRATOR:KRISHNA, SUSHMAFACILITY TYPE:
850
ADDRESS:330 RAVENSWOOD AVE.TELEPHONE:
(650) 322-2628
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:55CENSUS: 44DATE:
03/22/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sushma KrishnaTIME COMPLETED:
01:17 PM
ALLEGATION(S):
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Staff did not follow protocols to prevent the spread of illness.
Staff left child unsupervised for an extended period of time.
Lack of reporting to department.
INVESTIGATION FINDINGS:
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**This is an amended report**

On 3/22/22, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced inspection to deliver findings and close complaint. LPA met with Director, Sushma Krishna and explained the purpose of the inspection. Present in the facility are 10 staff caring for 44 children. All staff are fingerprint cleared and associated. During today's visit, LPA interviewed Director.

During the course of the investigation, review of facility records, physical plant, and interviews to staff and children were conducted. As well, as received pertinent documentation.

Based on interviews and pertinent information, it has been confirmed that Staff did not follow protocols to prevent the spread of illness and did not report to department in a timely manner. Also, it has been confirmed that Staff left child unsupervised for an extended period of time. Therefore, the preponderance of evidence standard has been met, so allegations are found to be SUBSTANTIATED.

***See attached page for deficiencies cited against the facility under CCR,Title 22, Div. 12, Chapt. 1.***

After today’s visit, an exit interview was conducted with Director, Sushma Krishna. A copy of this report will be emailed to to Director at SKRISHNA@TRINITY-MP.ORG. Upon receipt of this report, Licensee shall post the Notice of Site Visit. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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-20220124140009
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: TRINITY PRESCHOOL
FACILITY NUMBER: 410503217
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/01/2022
Section Cited
CCR
101223(a)(2)
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**This page has been amended**

101223(a)(2):The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met as evidenced by:
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Facility will follow sick/covid policy that are in place. Facility will have a meeting with staff to review protocols.
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Based on observation and interviews conducted, the facility did not ensure the personal rights of persons in care to be safe and healthful accommodations by not following sick/covid protocols in placed by the facility. This poses a potential health, safety or personal rights risk to children in care.
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Request Denied
Type B
04/01/2022
Section Cited
CCR
101229(a)(1)
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101229(a)(1):The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation

This requirement is not met as evidenced by:
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Facility will ensure that children are supervised at all times. Facility will have a meeting with staff to review protocols.
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Based on interviews with staff, it was determined that a child was left unsupervised without direct visual observation for a period of time. This poses a potential health, safety or personal rights 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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 05-CC-20220124140009
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: TRINITY PRESCHOOL
FACILITY NUMBER: 410503217
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/23/2022
Section Cited
CCR
101212(d)(1)
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**This is an amended report**

101212 Reporting Requirements (d)(1)(C) … during the operation of the child care center…a report shall be made to the Department…within the Department’s next working day and during its normal business hours…Events reported shall include…any unusual incident…that threatens the…health or safety of any child.

This requirement was not met as evidence by:
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Facility will follow Reporting Requirements by reporting Unusual Incidents (including covid related) within 24 hours of occurance and follow up with an Unusual Incident Report in writing using LIC 624 within 7 days.
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Based on interviews and record review, children and staff had tested positive. Facility failed to report incident to Department verbally within 24 hours and written within 7 days. This poses a potential health, safety or personal rights 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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3