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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517145
Report Date: 04/05/2022
Date Signed: 04/05/2022 04:35:07 PM


Document Has Been Signed on 04/05/2022 04:35 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:IHSD, INC-HALF MOON BAY HEAD START CENTERFACILITY NUMBER:
410517145
ADMINISTRATOR:ALOLOR, LAURICEFACILITY TYPE:
850
ADDRESS:900 NO CABRILLO HIGHWAYTELEPHONE:
(650) 726-3869
CITY:HALF MOON BAYSTATE: CAZIP CODE:
94019
CAPACITY:20CENSUS: 17DATE:
04/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Laurice AlolorTIME COMPLETED:
04:45 PM
NARRATIVE
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On 4/5/2022 at 2:10P.M., Licensing Program Analyst, (LPA) Luis J. Gomez met with Director, Laurice Alolor. The purpose of today's inspection was explained and is in response to an incident that had occurred on February 16, 2022. Incident was self- reported to the department by facility management and involved a preschool child who was left alone in facility's outdoor play yard. Present was the director and 2 staff supervising 17 children. All children present had been properly signed in. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

During the inspection, LPA performed observations, interviewed staff and site director.

During interview with director, it was reported that on 2/16/2022 at 11:25A.M., during classroom transition, day-care child, C1, was left alone in the facility's outdoor play yard. Per staff, C1, was brought inside after two minutes. Director stated she immediately notified child’s authorized representatives and all parents.

On 2/23/2022, in response to the incident, facility conducted policy training with all site personnel. During training, director and staff reviewed regulation regarding child supervision and best practice strategies during classroom transitions. Copies of the staff- signed policy acknowledgements and meeting notes were submitted to LPA during today's inspection.

Director stated she will ensure she and all classroom staff, are conducting thorough child counts, especially after classroom transitions.

As a result of the occurrence of this incident, a violation of the Title 22 Division 12 of Ca. Code of Regulations was observed, and deficiency was cited on the attached 809D. An exit interview was conducted with Director. A copy of this report with the appeal rights was provided, and signature of this form acknowledges receipt of these documents.

Notice of Site Visit for was provided during inspection.

This report must be available in the facility for public review. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2022
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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Document Has Been Signed on 04/05/2022 04:35 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: IHSD, INC-HALF MOON BAY HEAD START CENTER
FACILITY NUMBER: 410517145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/05/2022
Section Cited

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101229(a)(1) Responsible for providing Care and Supervision: 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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Based on interviews and record review, LPA confirmed day-care child, C1, was left alone in the outdoor play yard for two minutes. This poses a potential health and safety risk to children in care.
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Deficiency was cleared during inspection.

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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: 04/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2