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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380504793
Report Date: 01/10/2022
Date Signed: 01/10/2022 12:55:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2022 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220103112700
FACILITY NAME:TELEGRAPH HILL NURSERY SCHOOLSFACILITY NUMBER:
380504793
ADMINISTRATOR:LUU, CONNIEFACILITY TYPE:
850
ADDRESS:660 LOMBARD STREETTELEPHONE:
(415) 421-6443
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94133
CAPACITY:87CENSUS: 50DATE:
01/10/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Asako McgeeTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Child was left unsupervised.
INVESTIGATION FINDINGS:
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On 1/10/2022 at 9:25A.M., Licensing Program Analyst (LPA) Luis J. Gomez met with Site Supervisor, Asako Mcgee at the facility. Purpose of inspection was explained and was for an unannounced complaint investigation. Present was Site Supervisor and 9 staff supervising 50 children. Children present were properly signed in. LPA inspected facility with site supervisor for health and safety hazards.

During today’s inspection, LPA performed site observations, interviewed staff, collected evidence and reviewed facility records.

During the course of the investigation, site observations were conducted on 1/10/2022. A review of the facility records was completed, which included the personnel rosters (LIC500), and classroom sign-in sheets. LPA conducted interviews with the Site Supervisor, staff and all involved parties. Regarding allegation of child was left unsupervised; Based on interviews and evidence collected, LPA confirmed day-care child was left unsupervised inside facility play yard for three minutes. (REFER TO LIC9099C FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 05-CC-20220103112700
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: TELEGRAPH HILL NURSERY SCHOOLS
FACILITY NUMBER: 380504793
VISIT DATE: 01/10/2022
NARRATIVE
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(Page 2)
Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation(s) are found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1 are being cited on the attached 9099-D.) Appeal Rights were provided to the facility.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment and appeal have

Signed copy of this report was emailed to the Site Supervisor.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 05-CC-20220103112700
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TELEGRAPH HILL NURSERY SCHOOLS
FACILITY NUMBER: 380504793
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2022
Section Cited
CCR
102029(a)(1)
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102029(a)(1) Responsibility for Providing Care and Supervision: 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). Supervision shall include visual observation. This requirement was not met as evidenced by:
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Per director, facility will conducted all staff training reviewing program's policy on proper care and supervision of day-care children. Director will submit agenda with covered topics and signatures of staff attendance by the due date: 1/17/2021
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Based on interviews and evidence collected, LPA confirmed day-care child was left unsupervised inside facility play yard for three minutes. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the Department via email.
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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.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4