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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414000219
Report Date: 06/21/2024
Date Signed: 06/21/2024 12:22:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
06/19/2024 and conducted by Evaluator Kassandra Medrano
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240619121559
FACILITY NAME:LITTLEST ANGELSFACILITY NUMBER:
414000219
ADMINISTRATOR:KATHLEEN O'MALLEYFACILITY TYPE:
850
ADDRESS:1075 CLOUD AVENUETELEPHONE:
(650) 854-4973
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:102CENSUS: 26DATE:
06/21/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kathleen O'malley and Johnathan CoyneTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in child exiting facility alone.
INVESTIGATION FINDINGS:
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On June 21, 2024, Licensing Program Analyst (LPA) Kassandra Medrano and Licensing Program Manager (LPM) Ali Zebila met with Director, Kathleen “Katie” O’Malley and Director of Ministries, Jonathan Coyne for an unannounced initial 10-day investigation inspection. The purpose of the visit was explained.
Based on interviews, observations, as well as information gathered; it was found that C1 left preschool campus without the knowledge of staff. Facility is unsure when or how the child exited the campus. Based on evidence gathered, this incident resulted in absence of supervision because the child was left without visual supervision of staff. The allegation noted above is thus found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.
A Type “A” violation and civil penalties were issued today. The center was advised to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. Notice of Site Visit and Type A Citation shall remain posted for 30 days.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):
Exit interview conducted and report was reviewed with the Director, Kathleen.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
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 2
Control Number 05-CC-20240619121559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LITTLEST ANGELS
FACILITY NUMBER: 414000219
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2024
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Responsibility for Providing Care and Supervision
(a) 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.. Supervision shall include visual observation.
This requirement was not as evidenced by:
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Director to submit an action plan to RO to provide training to staff regarding supervision. Plan must include what is covered in training as well as signatures of staff included in this training.
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Based on staff interviews and documents recieved, on 6/19/24, C1 left campus without knowledge of staff resulting in absence of supervision. This posed an immediate health and safety risk to children enrolled.
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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: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2