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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000037
Report Date: 03/15/2023
Date Signed: 03/15/2023 12:40:34 PM

Document Has Been Signed on 03/15/2023 12:40 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:ALTA PLAZA PRESCHOOLFACILITY NUMBER:
384000037
ADMINISTRATOR:ERIKA TINOCOFACILITY TYPE:
850
ADDRESS:2140 PIERCE STREETTELEPHONE:
(415) 928-6483
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 17DATE:
03/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Erika TinocoTIME COMPLETED:
12:50 PM
NARRATIVE
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On March 15, 2023, at approximately 11:40am, Licensing Program Analyst (LPA) Ly conducted a Case Management Inspection at the facility due to a self reported incident. During today's visit, LPA met with facility Executive Director Erika Tinoco. There were 17 children and 4 staff including the Executive Director present during today's visit.

During today's visit, LPA interviewed Executive Director regarding the self reported Unusual Incident Report. Based on interview, a 2 years and 6 month old child was left at the nearby park. Child was found by a bystander walking the dog in the park. Per Director, the bystander stayed with child until a staff came to collect child. Child was there for approximately 10 minutes. Per Director, family of child was informed and facility held a meeting with family regarding future plans on how issues like this will not happen again.

Based on interview and information collected, facility violated the Care and Supervision Regulation. LPA discussed protocols and policies with the supervisor and advised that they need to develop protocols to prevent future incidents. Child was left unattended at a nearby park poses an immediate health and safety risk to children in care. Type A deficiency is being cited today in accordance with in accordance with the California Code of Regulations, Title 22, see LIC 809D. Immediate Civil Penalty $500 Assessed on this day.

Plans of Corrections (POC) were developed and reviewed with Director. A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to licensee. Licensee was advised Notice of Site Visit to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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Document Has Been Signed on 03/15/2023 12:40 PM - It Cannot Be Edited


Created By: Winnie Ly On 03/15/2023 at 12:13 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: ALTA PLAZA PRESCHOOL
FACILITY NUMBER: 384000037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2023
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
This requirement was not met as evidence based on interviews conducted with Director
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Staff have been reminded to make sure to always maintain 100% supervision of a child, 100% of the time. Facility have put in place having children wear red penny vest to easily identify children at the park, always keep track of children with headcounts and record keeping.
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Child was left unattended at the nearby park. A bystander found child and waited with child until facility staff came back to collect the child.
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This facility will be scheduled for a Non- Compliance conference at the Peninsula Regional Office. Letter of Non Compliance will be mailed to the facility with a date and time of the Non-Complaince Conference.

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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:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023


LIC809 (FAS) - (06/04)
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