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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213001939
Report Date: 08/14/2024
Date Signed: 08/14/2024 01:30:17 PM

Document Has Been Signed on 08/14/2024 01:30 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:C.A.M. (CFS) HAMILTON (PS)FACILITY NUMBER:
213001939
ADMINISTRATOR/
DIRECTOR:		ALIDA LEONFACILITY TYPE:
850
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-5232
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 31DATE:
08/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Alida LeonTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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
On August 14, 2024, Licensing Program Analyst (LPA) Garcia made an unannounced case management visit to the child day care facility listed above and met with Site Supervisor, Alida Leon. Purpose of the visit was explained to the director. The case management visit is from a self reported incident that occurred on 7/30/2024. The facility had 31 children and 13 teachers supervising the children in three rooms during the visit.

The day of the incident, July 30, 2024, the student shared with her grandmother that teacher from room 4 allegedly put her hand on the child's head hard because the child was playing during nap time. According to the report, the student disclosed this incident to the grandmother at pick up time.

LPA Garcia interviewed the 2 staff members from room 4 regarding the incident. LPA also obtained a copy of the training that the Site Supervisor went over such as personal rights and writing incident reports. According to Alida, the Human Resources are still in the process of investigating the incident and the teacher in question is still on leave. Based on the interviews and documents obtained and conducted by LPA, children's personal rights were violated.

Type B Violation for violating child's Personal Rights.

A copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Site Supervisor, Alida Leon.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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
Document Has Been Signed on 08/14/2024 01:30 PM - It Cannot Be Edited


Created By: Nathan Garcia On 08/14/2024 at 01:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: C.A.M. (CFS) HAMILTON (PS)
FACILITY NUMBER: 213001939

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
CCR
101223(a)(1)

1
2
3
4
5
6
7
101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The facility leadership and Human Resources will conducted an investigation and the staff member was put on administrative leave.
8
9
10
11
12
13
14
The child's personal rights were violated when the staff member pushed the child's head down on the cot during nap time. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
The citation will be issued and cleared on the same visit.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2