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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102905
Report Date: 04/30/2024
Date Signed: 04/30/2024 01:52:30 PM


Document Has Been Signed on 04/30/2024 01:52 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:SAN ANSELMO PRESCHOOLFACILITY NUMBER:
210102905
ADMINISTRATOR:NEWMAN,KATHYFACILITY TYPE:
850
ADDRESS:121 ROSS AVENUETELEPHONE:
(415) 453-3181
CITY:SAN ANSELMOSTATE: CAZIP CODE:
94960
CAPACITY:75CENSUS: 57DATE:
04/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Kathy NewmanTIME COMPLETED:
02:05 PM
NARRATIVE
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On 4/30/2024, Licensing Program Analysts (LPAs) Leong and Zaragoza conducted an unannounced case management visit to the Child Care Center (CCC) listed above. The purpose of the visit was to follow up on an incident involving a child on 4/24/2024. LPAs met with the Director, Kathy Newman, and explained the purpose of the visit. Fifty-seven preschool-aged children and fourteen staff members were present during the visit. The fourteen staff members present at the CCC have all received criminal record clearance from the department. The CCC operates within its capacity and in accordance with the required ratio of staff to children.

According to Ms. Newman, the incident involving the child leaving the facility occurred during pick-up time, approximately 4:30 p.m. According to Newman, the child walked out of the facility for approximately two minutes. According to Ms. Newman, the child was found by her father, who notified a staff member that the child was found outside of the property on her own. According to Ms. Newman, she had a meeting with the staff on 4/26/2024 regarding the lack of supervision involving the child who left the property.

The department's investigation concluded that there was a lack of supervision when the child left the site alone and walked outside the facility without the knowledge of the staff. This conclusion was based on the findings of the staff interview and the incident report received on 4/26/2024. As a result of this incident, a $500 civil penalty will be assessed today.



LPAs informed the director to provide a copy of this licensing report dated 4/30/2024 that documents any Type A citations to the parents or guardians of all children currently enrolled by the next business day or the next day the children are in care and to the parents or guardians of any newly enrolled children for a period of 12 months from the date of this report. The deadline for providing this information is the next day, 5/1/2024. For the purposes of verification, the child's file needs to have either a signed Acknowledgement of Receipt of Licensing Report (LIC 9224) or another type of written statement.

Please refer to LIC 809D for today's citation

Appeal Rights were given to the Director, Kathy Newman

LIC 809D was given and must remain posted for 30 days.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Kathy Newman

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
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 04/30/2024 01:52 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: SAN ANSELMO PRESCHOOL
FACILITY NUMBER: 210102905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision...children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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A staff meeting was held on 4/26/2024 regarding the lack of supervision. A proof of attendance from all staff will be required. The proof of attendance must be submitted to the department by 5/1/2024.
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This requirement is not met as evidenced by:
Based on interview and record review, the licensee did not comply with the section cited above, which poses an immediate health, safety, or personal rights 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.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
LIC809 (FAS) - (06/04)
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