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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414001947
Report Date: 01/19/2023
Date Signed: 01/19/2023 04:30:59 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
12/20/2022 and conducted by Evaluator April Cowan
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20221220140606
FACILITY NAME:FOOTSTEPS@NESBIT PUMA CUBS(PRESCHOOL)FACILITY NUMBER:
414001947
ADMINISTRATOR:LABUCAY, DEBORAHFACILITY TYPE:
850
ADDRESS:500 BIDDULPH WAYTELEPHONE:
(650) 226-3356
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:44CENSUS: 33DATE:
01/19/2023
UNANNOUNCEDTIME BEGAN:
03:52 PM
MET WITH:Deborah Labucay and Karen FolettaTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff uses unusual forms of discipline with children in care
INVESTIGATION FINDINGS:
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On January 19, 2023, at 3:40 PM, Licensing Program Analyst (LPA) Cowan met with site director Deborah Labucay and Karen Foletta, for an unannounced subsequent complaint inspection. The purpose of inspection was explained. Present in the facility is director and 9 staff caring for 33 children. In today’s inspection, LPA interviewed staff.

During the course of investigation, it has been confirmed that staff played the "Fake Police for Kids" vidoe to encourage a child to behave. Based on LPA's interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is founded to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
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-20221220140606
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: FOOTSTEPS@NESBIT PUMA CUBS(PRESCHOOL)
FACILITY NUMBER: 414001947
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2023
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by:
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Director agrees to train staff on appropriate discipline and email agenda and signatures of attendants to LPA by 1/27/23
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Based on interviews, it has been confirmed that staff played the "Fake Police for Kids" video for a child that was misbehaving. This is a potential 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.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2