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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003001
Report Date: 07/27/2023
Date Signed: 07/27/2023 04:00:01 PM


Document Has Been Signed on 07/27/2023 04:00 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:ST. MICHAEL INFANT CARE CENTERFACILITY NUMBER:
414003001
ADMINISTRATOR:NIVEN ESCANDERFACILITY TYPE:
830
ADDRESS:401 HUDSON STREETTELEPHONE:
(650) 690-8230
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:20CENSUS: 5DATE:
07/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Mary WilliamTIME COMPLETED:
04:20 PM
NARRATIVE
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On July 27, 2023 at 2:35 PM, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted a Case Management visit in response to an Incident LPA observed on July 17, 2023. LPA met with Director and explained the purpose of visit. On the day the incident incurred, LPA called Director to inform her of what LPA had observed.

The incident involved a lack of supervision that resulted when a teacher, responsible for supervising four infants during outside time, walked away from 3 infants for a few seconds to hand off another infant for a diaper change. Which left three infants in the play yard without direct visual supervision. During today's visit, Director shared video footage of the infant play yard and the normal occurrence for diaper changing protocol. In the video, LPA observed it was a one time incident, videos viewed showed protocol is maintained for outside supervision. Director stated teacher was a new hire and had been trained to follow procedures. Based on the conversation with Director, it was determined that teacher stepped away from infants to quickly hand off child for a diaper change and resulted in lack of supervision on July 17, 2023. Teacher did not maintain direct visual observation of then infants during the quick hand off of another infant for a diaper change. This is a potential risk to children in care. A type B violation is issued this day. See LIC 809D.

Director and lead teacher responded immediately to the occurrence of this incident and spoke to Teacher regarding policies and procedures for providing care and supervision to children at all times. Director and staff have intensive training and have a developed system, where teachers stand at the outside corner of classroom if they need assistance and where teachers can maintain direct visual supervision of infants in care. Per Director, teacher was dismissed. All staff are aware that direct supervision is to be maintained on infants at all times. Facility is equipped with video surveillance and teachers also use cell phone when needed to communicate with staff.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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 07/27/2023 04:00 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: ST. MICHAEL INFANT CARE CENTER
FACILITY NUMBER: 414003001

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/27/2023
Section Cited
CCR
101429(a)(1)

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101429(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended.

LPAs observed three infant left unsupervised while teacher handed off another infant for a diaper change.
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A Staff immediately returned to the infants outside.

The Director shall ensure that each infant shall be under direct visual observation and constantly supervised by a staff person at all times. Under no circumstances shall ANY infant be left unattended by the due date. Director reviewed supervison protocal with all staff.

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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: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
LIC809 (FAS) - (06/04)
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