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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001491
Report Date: 01/17/2023
Date Signed: 01/17/2023 12:49:42 PM

Document Has Been Signed on 01/17/2023 12:49 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LETTERMAN DIGITAL ARTS CCC (PRESCHOOL)FACILITY NUMBER:
384001491
ADMINISTRATOR:CHONA ROBERTO-CHENGFACILITY TYPE:
850
ADDRESS:1 LETTERMAN DR., BLDG. BTELEPHONE:
(415) 746-5444
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94129
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 54DATE:
01/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Vicky Patel and Sherri IrvingTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection today. LPA met with the Site Director, Vicky Patel, and Assistant Site Director, Sherri Irving, and explained the purpose of the inspection to them. There were 54 children with 20 staff present. The facility self reported an unusual incident report on 1/12/23 regarding a staff handled a child inappropriately that caused a child was injured. LPA interviewed witness during the inspection. Based on the interviews and relevant document gathered by LPA, there was the sufficient evidence to prove a staff handled a child inappropriately that ended up a child was injured.




*Please see next page for deficiency cited under CCR, Title 22, Div. 12, Chapter 1:











An exit inspection was conducted with the Site Director and appeal rights were explained. A printed copy of the report, as well as a printed copy of the appeal rights, were provided to the Licensee at the conclusion of the inspection. Notice of site visit was posted and must remain posted for 30 days for public review.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/17/2023 12:49 PM - It Cannot Be Edited


Created By: Cindy Mok On 01/17/2023 at 11:15 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: LETTERMAN DIGITAL ARTS CCC (PRESCHOOL)
FACILITY NUMBER: 384001491

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2023
Section Cited
CCR
101223(a)(2)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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The licensee must set up a plan to prevent the same or similar incident happening in the facility and submit the plan to CCL by the due date 1/24/2023.
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This requirement was not met as evidence-based upon interviews and relevant document; a child was injured due to a staff handled inappropriately.

This poses a potential health risk to children in care.

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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:Cindy Mok
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023


LIC809 (FAS) - (06/04)
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