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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001686
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:59:11 PM

Document Has Been Signed on 02/18/2025 04:59 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:TOLBERT, JOSEPHINEFACILITY NUMBER:
384001686
ADMINISTRATOR/
DIRECTOR:		TOLBERT, JOSEPHINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 424-9016
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 5DATE:
02/18/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:39 PM
MET WITH:Josephine TolbertTIME VISIT/
INSPECTION COMPLETED:
05:05 PM
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On February 18, 2025, Licensing Program Analysts (LPAs) Leong and Naves conducted an unannounced plan of correction (POC) visit. The visit was to follow up on the Type A deficiency cited on February 11, 2025. LPAs met with the Licensee, Josephine Tolbert, and explained the purpose of the visit.

Today’s visit included the five children (four school-aged and one pre-k) and the licensee.

LPAs observed that the two previous notice of site visits were displayed from January 28, 2025, and February 11, 2025. The Type A violations from January 28, 2025, and February 11, 2025, were also displayed on the wall, meeting the posting requirements for a family childcare home.

On February 11, 2025. the facility was issued a Type A deficiency for using the upstairs level, which is off-limits for the children.

During today’s visit, at 2:40 pm, LPAs observed that the three children (C1, C2, and C3) were using the upstairs, which is off-limits to the children. LPAs observed there was no child safety gate downstairs to prevent access to the upper level. At 3:45 pm, the fourth child (C4) arrived at the facility. At 4:20 pm, the fifth child (C5) arrived at the facility. The licensee stated she had not been able to draft a letter to the department indicating the facility would like to use the upstairs. The facility will be issued a civil penalty of $600 for failing to correct the deficiency from February 11, 2025.

LPAs discussed with the licensee that the designated off-limit areas of the home cannot be utilized until the department receives a formal written request expressing the facility's desire to use those areas. Additionally, the department must approve this request before the licensee can proceed with using the specified off-limit areas.

LPAs discussed the required documents for child records with the licensee. An entrance checklist, LIC 126, was given to the licensee during today’s visit.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: TOLBERT, JOSEPHINE
FACILITY NUMBER: 384001686
VISIT DATE: 02/18/2025
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LPAs discussed with the licensee the other Type B deficiencies cited on February 11, 2025, and reminded that the plan of correction for each Type B deficiency must be submitted to the department by March 11, 2025.

LPAs reminded the licensee that the department would continue to issue civil penalties of $100 per day if this deficiency and other deficiencies were not corrected by the specified deadline agreed upon the visit.

LPAs discussed with the licensee that any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes.

During the visit, LPAs collected the appeal letter from the licensee. The appeal letter is for deficiency cited on January 28, 2025

LPAs provided the licensee with a department-drafted letter indicating she must attend a required office meeting at the San Bruno Regional Office on February 28, 2025. LPAs informed the licensee that she must notify the department if she needs to change the office meeting schedule. The office meeting is mandatory.

The licensee informed the LPAs that she had not reviewed the department’s February 11, 2025, report. Per the licensee, she requested LPAs to go over the report with her from February 11, 2025. LPAs went over the report with the licensee.

Appeal Rights were given and discussed with the licensee.

A Notice of Site Visit was given and must remain posted for 30 days.

The licensee declined to sign today's report and the LIC 421FC.

Exit interview conducted and report was reviewed with the Licensee, Josephine Tolbert.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
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