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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001493
Report Date: 04/16/2024
Date Signed: 04/16/2024 03:59:43 PM


Document Has Been Signed on 04/16/2024 03:59 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SHORES CHILD DEVELOPMENT CENTERFACILITY NUMBER:
414001493
ADMINISTRATOR:ROBINSON, ONEIKIFACILITY TYPE:
830
ADDRESS:1050 TWIN DOLPHIN DRIVETELEPHONE:
(650) 594-1100
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY:112CENSUS: 20DATE:
04/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Director, Lisa BeckerTIME COMPLETED:
01:30 PM
NARRATIVE
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On April 16th, 2024 at approximately 12pm, Licensing Program Analyst (LPA) Tapia-Mandujano arrived at the facility to conduct a Case Management-Incident inspection. LPA met with Director, Lisa Becker. The purpose of today's inspection was explained. Inspection is for a response to an Unusual Incident Report that was received by the department on April 2nd, 2024.

Present in the facility are 20 infant children being supervised by 7 staff. All staff present at this time are fingerprint cleared and associated.

The facility self reported an incident that occurred on March 29th, 2024. The incident involved lack of supervision that resulted in a child being left unsupervised while transitioning from outside of the classroom back to the inside of the classroom. Per interviews and report, the teacher had 3 infant children walking back to the classroom, and one infant child ran off from the group and made it to the stairs that lead to the preschool classrooms. Per S1, the child was left unattended for about a minute.

During today's inspection, LPA inspected the area where the incident took place. LPA spoke with Director and involved staff about the incident. Parent of unsupervised child was notified. Per Director, immediate action was taken and retraining has since happened.

Due to a potential health and safety risks for lack of supervision, a Type B deficiency has been issued. Please see LIC 809D for more details.

This report must be available in the facility for public review. Appeal Rights were provided. Notice of site visit shall be posted for 30 days from today's visit. An exit interview was conducted with Director, Lisa Becker.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024
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 2


Document Has Been Signed on 04/16/2024 03:59 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SHORES CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 414001493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2024
Section Cited
CCR
101229(a)(1)

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101229 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 met as evidenced by:
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Director has held an all staff meeting on April 4th, 2024 to retrain on transitioning and supervision policies. Action Plan was submiited via email on 4/12/24.

Director will continue to check in on staff during trasitions to ensure the policies are being followed.
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Based on interview and record review, the facility did not comply with the section cited above as facility self reported that there was a child who was unsupervised during transition back to the classroom from the hallway, which poses a potential health, safety or personal rights risk to persons in care.
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Office Meeting may be scheduled.

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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: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024
LIC809 (FAS) - (06/04)
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