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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002201
Report Date: 12/10/2024
Date Signed: 12/10/2024 03:33:27 PM

Document Has Been Signed on 12/10/2024 03:33 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:FACESSF - MASONIC PRESCHOOLFACILITY NUMBER:
384002201
ADMINISTRATOR/
DIRECTOR:
MEI NA CHANFACILITY TYPE:
850
ADDRESS:1101 MASONIC AVENUETELEPHONE:
(415) 355-0210
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 71TOTAL ENROLLED CHILDREN: 71CENSUS: 29DATE:
12/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Director, Mei ChanTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On 12/10/2024, at approximately 2:35PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced case management visit at the facility. LPA met with Director, Mei Chan and explained the purpose of the visit. Present during the visit was the Director, 12 staff members, and 29 preschool age children. The facility is operating within staffing and ratio requirements on this day.

The facility submitted an incident report on 11/21/2024 regarding an incident where a child ran out of a classroom into the facility's inclusion room. The childproof gate in the classroom was broken as a result. Teachers present were able to retrieve the child and immediately brought them back to the classroom. This is a self-reported incident.

During today's visit, LPA conducted site observations, record review, and interviewed relevant parties. LPA observed that the inclusion room was directly across the hall from the classroom. LPA reviewed the child's file and found that incident reports and correspondence with responsible parties was documented and maintained. The incident report submitted to the Regional Office was submitted in a timely manner. Per Director, staff trainings and meetings have emphasized supervision of children in care. The facility has taken corrective action and coordinated an action plan with the authorized representative. New childproof gates were delivered and will be installed in classrooms as needed.

Based on LPA's site observations, record review, and interview, no violation of California Code of Regulations, Title 22 was found to have occurred. No deficiencies were cited during today's visit on 12/10/2024. A notice of site visit was provided and must remain posted to 30 days.

Exit interview conducted and report was reviewed with Director Mei Chan.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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