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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004560
Report Date: 11/07/2019
Date Signed: 11/07/2019 10:46:01 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:AMIGOS DE SFFACILITY NUMBER:
414004560
ADMINISTRATOR:CARNIGLIA, JULIEFACILITY TYPE:
850
ADDRESS:1020 SULLIVAN AVENUETELEPHONE:
(650) 218-1555
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:22CENSUS: 4DATE:
11/07/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mariela Gonzalez ArredoTIME COMPLETED:
11:00 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) Farhan Bashir-Tariq met with teacher Mariela Gonzalez to conduct a Case Management Inspection today in response to an unusual incident report that Department received on October 31, 2019. Facility self-reported the incident. Present there were 4 children in care with 2 staff. Facility is operating within the licensed capacity and ratio limits as of today 11/7/19. Background check clearance for the staff present today is already on file.

This incident occurred, when a child playing in art area got his leg stuck between the two bars of the side railing around the art area. There were 6 children present in/or around the art area at the time of incident with 2 teachers. During today's inspection, LPA inspected the inside area of the facility including the art area for health and safety hazards. LPA did not observe any health and safety hazards. LPA spoke to teacher Mariela Gonzalez about the incident and actions that were taken after the incident. Child's leg was stuck in the railing for 10 minutes approximately. Teachers tried to free the child by pulling the leg out themselves but were unable to do so. Paramedics were called at that point. Paramedics arrived at the facility within five minutes and released child's leg from railing. Paramedics did a full physical check on child's leg and found him to be OK. Child was able to stand, walk, jump and run after the incident. Child did not miss any days from school due to the incident.

Management responded to the incident immediately. Mother of the child was informed about the incident straightaway. Facility installed a netting on 11/5/19 all around the railing to block it from any future occurrences. Facility was also advised to take precautions in future before installing any furniture or equipment. No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. Facility was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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 1