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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505568
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:37:09 PM

Document Has Been Signed on 02/15/2023 02:37 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)FACILITY NUMBER:
380505568
ADMINISTRATOR:QUIROZ, YOHANAFACILITY TYPE:
850
ADDRESS:2730 BRYANT STREETTELEPHONE:
(415) 282-1090
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 70DATE:
02/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Mechele PruittTIME COMPLETED:
02:40 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 2/15/2023 at 8:50AM. Licensing Program Analyst (LPA) Luis J. Gomez and met with Co-education director, Mechele Pruitt. Purpose of this report is to cite deficiencies observed during unannounced, complaint inspection. Present were 12 staff supervising 70 children. LPA inspected facility for health and safety hazards.

At 9:50AM., Based on observations, LPA confirmed large container of Ibuprofen tablets located on shelf in blue birds classroom. Medication was removed during inspection.



Based on today’s inspection, deficiencies were observed in areas evacuated according the Title 22, Division 12, Chap, 3 of Ca, Code of Regulations and cited on the 809D. An exit interview, report, appeal rights, and plan of correction was discussed with the Director, Mechele Pruitt and signature of this form acknowledges the receipt of these documents.

A copy of this report and appeal rights were reviewed and provided to the licensee. Notice of site visit was posted and shall remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 02/15/2023 02:37 PM - It Cannot Be Edited


Created By: Luis Gomez On 02/15/2023 at 01:56 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: FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)
FACILITY NUMBER: 380505568

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2023
Section Cited
CCR
101238(g)

1
2
3
4
5
6
7
101238(g) Building and Grounds: (g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility removed tablets from classroom during today's inspection. Director stated she will review protocol with staff regarding personal items brought into the classroom.
8
9
10
11
12
13
14
At 9:50AM, LPA confirmed large container of Ibuprofen tablets located on shelf in blue birds classroom. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14

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:Ali Zebila
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


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