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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003012
Report Date: 06/06/2023
Date Signed: 06/06/2023 03:08:31 PM


Document Has Been Signed on 06/06/2023 03:08 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. MATTHEWS EPISCOPAL DAY SCHOOLFACILITY NUMBER:
414003012
ADMINISTRATOR:HUDEC, ERINFACILITY TYPE:
850
ADDRESS:15 2ND AVENUETELEPHONE:
(650) 342-5436
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:34CENSUS: 15DATE:
06/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Erin HudecTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced case management visit to discuss an incident that occurred on May 19, 2023. LPA met with Site Director Erin Hudec and explained purpose of visit. Present at the school were the Site Director, three teachers, and 15 preschool children.

On the day of the incident, the preschool went to their Baldwin Campus for a morning event to celebrate the eighth graders. Preschool children were paired up with a seventh grade buddy during the event. After the event was finished, children and staff were walking to their gathering place inside the multipurpose room/Parish Hall so they could all walk outside together to have PE on the lawn before preschool children and staff returned to the preschool on Charles House Campus.

The buddy for child C1 received misinformation from another buddy that the buddy was supposed to return C1 back to their classroom and started walking C1 back to their classroom in tthe Charles House Campus. Staff had conducted a head count and immediately found C1 missing from the group. Staff followed protocol in looking for the child and one staff member was walking back to Charles House Campus when C1's buddy realized they went to the wrong location. Both C1 and C1's buddy were found immediately and escorted back to the Baldwin Campus. Child's mother was notified of the incident.

Per Site Director, when conducting walks from Charles House to the Baldwin Campus, a teacher flanks the children in front and in back of the line and a third teacher is in the middle of the group of children. Normal child to staff ratio are followed during their walks back and forth campus. Preschool children and staff attends events and does PE at Baldwin Campus at least three times a week and also attends Chapel every Friday. Site Director stated further review was conducted on their current procedures and protocols and a staff meeting was held to discuss the incident and how to prevent this incident from occurring in the future.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Exit interview was conducted and report was reviewed with Site Director Erin Hudec.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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