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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504444
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:11:12 AM

Document Has Been Signed on 12/18/2024 11:11 AM - 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SFUSD JOHN MCLAREN EARLY ED. SCHOOL (PRESCHOOL)FACILITY NUMBER:
380504444
ADMINISTRATOR/
DIRECTOR:		ANNA TOBINFACILITY TYPE:
850
ADDRESS:2055 SUNNYDALE AVENUETELEPHONE:
(415) 469-4519
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY: 96TOTAL ENROLLED CHILDREN: 29CENSUS: 19DATE:
12/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:11 AM
MET WITH:Anna Tobin TIME VISIT/
INSPECTION COMPLETED:
11:25 AM
NARRATIVE
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On 12/18/2024, Licensing Program Analysts (LPAs) Leong and Naves conducted an unannounced case management visit and met with the Director, Anna Tobin. The visit was to follow up on a self-reported incident involving a child (C1) that occurred on 12/4/2024. LPAs explained the purpose of the visit to the director.

Nineteen children and eleven staff members were present during the visit.

Based on staff interviews, C1 was left unsupervised in a classroom for a short time. On 12/6/2024, the director had the staff take additional training on responsibility for providing care and supervision. Proof of attendance that the training took place was provided to the LPAs during the visit.

After reviewing the Unusual Incident Report and staff interviews, LPAs concluded that the facility would be issued a Type A deficiency for a lack of supervision.

LPAs reminded the director to promptly provide a copy of this licensing report, dated 12/18/2024, that details any Type A citations to the parents or guardians of all currently enrolled children by the next business day or the next day the children are in care. This report must also be shared with 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, 12/19/2024, when the children are in care. For verification purposes, the child's file should include either a signed Acknowledgement of Receipt of Licensing Report (LIC 9224) or another form of written statement.

Please refer to LIC 809D for today’s citation.

Appeal Rights were given to the Director, Anna Tobin

A Notice of Site Visit and the LIC 809D were given, and both must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Anna Tobin.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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 12/18/2024 11:11 AM - It Cannot Be Edited


Created By: Hanson Leong On 12/18/2024 at 10:46 AM
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: SFUSD JOHN MCLAREN EARLY ED. SCHOOL (PRESCHOOL)
FACILITY NUMBER: 380504444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2024
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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On 12/6/2024, additional training was provided on responsibility for providing care and supervision. During the visit, the LPAs were provided with proof of attendance that the training took place.
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This requirement is not met as evidenced by:
Based on interview and record review, a child was left unsupervised in a classroom, which poses an immediate health, safety, or personal rights risk to children in care.
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The deficiency was cleared during today’s visit.

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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:Garfield Leung
LICENSING EVALUATOR NAME:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2024


LIC809 (FAS) - (06/04)
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