<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002733
Report Date: 12/16/2019
Date Signed: 12/16/2019 10:59:51 AM

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:EARLY LEARNING ACADEMYFACILITY NUMBER:
414002733
ADMINISTRATOR:VASQUEZ, VERONICAFACILITY TYPE:
850
ADDRESS:398 "F" STREETTELEPHONE:
(650) 755-8440
CITY:COLMASTATE: CAZIP CODE:
94014
CAPACITY:68CENSUS: 48DATE:
12/16/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Veronica VasquezTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection for a deficiency. LPA met with the Site Director, Veronica Vasquez. The purpose of the inspection was explained to her. There were 48 children with 8 staff present. LPA issued a deficiency for an incident that was brought up by a staff during the investigation. There was a teacher talked to another teacher with the loud voice in front of the children in the classroom on 9/23/2019.






*See next page of a deficiency cited under CCR,Title 22, Div. 12, Chapt. 1 today.







A Type “A” violation (see continuation) was issued today. The center is informed 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. This report and appeal rights were provided and reviewed with the Site Director. Notice of Site Visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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
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: EARLY LEARNING ACADEMY
FACILITY NUMBER: 414002733
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/17/2019
Section Cited

1
2
3
4
5
6
7
101223(a)(1) - Personal Rights:

To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by based upon interviews.
8
9
10
11
12
13
14
There was a teacher talked to another teacher with the loud voice in front of the children in the classroom on 9/23/2019.

This poses an immediate safety risk to children in care.

8
9
10
11
12
13
14
 Attendance and signatures will be sent to LPA by 1/10/2020.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2