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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384001949
Report Date: 09/27/2023
Date Signed: 09/27/2023 11:03:31 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
07/28/2023 and conducted by Evaluator Nathan Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230728161042
FACILITY NAME:POTRERO KIDS AT DANIEL WEBSTERFACILITY NUMBER:
384001949
ADMINISTRATOR:KEE, REBECCAFACILITY TYPE:
850
ADDRESS:465 MISSOURI STREETTELEPHONE:
(415) 625-9578
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94107
CAPACITY:38CENSUS: 34DATE:
09/27/2023
UNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Beatriz GomezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff handled daycare children in a unsafe manner.
Equipment accessible to children in care is not maintained in good condition.
INVESTIGATION FINDINGS:
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On September 27, 2023, Licensing Program Analyst (LPA), Nathan Garcia conducted an unannounced conclusionary complaint visit and met with site supervisor, Beatriz Gomez to discuss the above allegations. Purpose of the inspection was explained. Present are, 7 teachers with 34 children.

During the course of the investigation, interviews were conducted, observations were made, and pertinent documentation were reviewed. LPA has determined that the allegation of "Staff handled daycare children in a unsafe manner." and "Equipment accessible to children in care is not maintained in good condition." are SUBSTANTIATED, meaning the preponderance of evidence standard has been met. LIC 9099D is on the next page for the deficiency.

LPA conducted exit interview with Site Supervisor, Beatriz Gomez.

Report and Notice of Site Visit was provided.
Notice of Site Visit shall be posted for 30 consecutive days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
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 2
Control Number 05-CC-20230728161042
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: POTRERO KIDS AT DANIEL WEBSTER
FACILITY NUMBER: 384001949
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101238(a)
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101238 Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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The facility will follow up on the status of that work order and barricade or install foam surrounding the broken/sharp areas of the bench to protect the children.
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Based on interviews, observations conducted and pertinent documents received, the facility has contacted the school district to repair the borken bench, which dates back over one year and the work order is still pending. These pose a potential health and safety risk to children in care.

This requirement has not been met as evidenced by:
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The temporary repair shall be installed and an updated status of the work order from the school district will be sent to LPA by set due date.
Type B
10/27/2023
Section Cited
CCR
101223(a)
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101223 Personal Rights

(a) The licensee shall ensure that each child is accorded the following personal rights

This requirement has not been met as evidenced by:
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The facility will develop a plan of correction that will determine the games and activities played with the children are safe.
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Based on observations conducted and pertinent documents received, the activity that the staff was playing with the children was unsafe. This pose a potential health and safety risk to children in care.
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The facility will send proof to LPA by set due date.
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: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2