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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213006109
Report Date: 07/11/2023
Date Signed: 07/11/2023 12:03:45 PM

Document Has Been Signed on 07/11/2023 12:03 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) MARIN HEAD START LYNWOOD (PS)FACILITY NUMBER:
213006109
ADMINISTRATOR:LOMBARDI, KELSEYFACILITY TYPE:
850
ADDRESS:1320 LYNWOOD DRIVETELEPHONE:
(415) 883-3791
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 17DATE:
07/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ana PinedaTIME COMPLETED:
12:15 PM
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On 6/19/23, LPA Garcia attempted to to visit the facility for an unannounced case management visit regarding an incident that occurred on June 8 2023. LPA was informed by Alida Leon on 6/17/23 that C.A.M facilities are open for Juneteenth. LPA called the phone numbers on file.

On 7/11/23 at 10:45 AM, Licensing Program Analyst (LPA) Garcia made an announced case management visit to the child day care facility listed above and met with site manager, Ana Pineda regarding a self reported incident that occurred on 6/8/2023. The facility has 17 kids and 4 teachers plus the director present during the visit.

Per Ana Pineda (Site Manager) on the day of the incident, she was with 4 children in the classroom and a parent came inside the classroom to pick up her child. The student, Julio Hernandez came up to the parent and thinking it was his mom picking him up. Staff followed the child but the parent left the door open while she was signing out and C1 saw the opportunity to run out of the classroom. The site manager immediately followed the child and asked another teacher next door, who had 2 children in care to keep an eye on the children in Ana's room. The staff next door opened the middle door to keep an eye on the other 2 children left. Per Ana, she followed the child all the way to the gate where the children and adults exist during pick up time. The child stopped at the gate and that is where Ana was able to convince the child to hold her hand and walk back to the classroom. The child was still within the facility's property and the child's parents were also informed of this incident at pick up time. According to Ana, Julio's parents were also having the same situation at their home.

LPA inspected the areas and the gates of where the incident occurred and advised Ana to inform the staff members and parents to always keep the doors closed during drop off and pick up times. Ana also suggested that they are planning on putting a soft barricade by the entrance of the classroom as extra layer of security. LPA also suggested a chain latch, such as the one on the gate surrounding the day care. Staff will email the elementary school if such latch is permitted and will be put as another layer of precaution. Site manager will email a written plan of correction to LPA to prevent similar incidents from occurring.

Facility is given a technical violation under CCR 101229 Responsibility for Providing Care and Supervision for the incident.

Exit interview was conducted and report was reviewed with Area Manager, Ana Pineda.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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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