384002202-8-7-2026-05-CC-HLEG-DWQNWT-20260807105004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002202
Report Date: 08/07/2026
Date Signed: 08/07/2026 10:50:18 AM

Document Has Been Signed on 08/07/2026 10:50 AM - 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 - HAYES VALLEY CDC (INFANT)		FACILITY NUMBER:	384002202
ADMINISTRATOR/ DIRECTOR:	STEPHANIE KUYPER		FACILITY TYPE:	830
ADDRESS:	305 BUCHANAN STREET		TELEPHONE:	(415) 552-1535
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY: 18	TOTAL ENROLLED CHILDREN: 18	CENSUS: 12	DATE:	08/07/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:37 AM
MET WITH:	Audrea Cain (S1) and Stephanie Kuyper (S2)		TIME VISIT/ INSPECTION COMPLETED:	11:05 AM

NARRATIVE

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On August 7, 2026, Licensing Program Analyst (LPA) Leong arrived at the facility to conduct an unannounced case management visit. LPA met with S1 and explained the purpose of the visit. S2, the director, arrived during the visit.

There were 12 children (5 toddlers and 7 infants) and 6 staff members present during the visit,

On July 30, 2026, the facility self-reported an incident in which a child (C1) left the facility without the on-site staff's knowledge. According to the Unusual Incident Report, S3 left the half-door open to transport the children's blankets to the cots, and C1 passed through the half-door and pressed the handicap-accessible door activation button. C1 then exited the facility for approximately four minutes before a passerby escorted C1 back to the facility.

According to S2, the facility will be closed from August 12 to 14, 2026. Staff will be on-site on August 14, 2026, for additional training focused primarily on supervision. According to S2, S3 will be on leave until the facility completes an internal investigation.

Based on interviews, record review, and a self-reported incident, a child was left unattended and unsupervised. The facility will be cited for a Type A deficiency for the absence of supervision. An immediate $1000 civil penalty was assessed against the facility.

LPA will require the facility to have a staff member stand at the half-door if it is propped open until S2 decides on a permanent fix.

LPA Leong informed facility representative Stephanie Kuyper that this report dated 8/7/2026 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

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Garfield Leung
Hanson Leong
	DATE: 08/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: FACESSF - HAYES VALLEY CDC (INFANT)	FACILITY NUMBER: 384002202
	VISIT DATE: 08/07/2026

NARRATIVE

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Also, LPA Leong informed the facility representative to provide a copy of this licensing report dated 8/7/2026 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Please see the next page for today's deficiency.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Stephanie Kuyper.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/07/2026 10:50 AM - It Cannot Be Edited

Created By: Hanson Leong On 08/07/2026 at 10:06 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: FACESSF - HAYES VALLEY CDC (INFANT)	FACILITY NUMBER: 384002202
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/10/2026 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision...children's needs... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Director will have an all staff meeting on 8/14/2026 regarding the supervision incident According to the Director, she will go over the child care regulations and health safety codes regarding supervision.
	8 9 10 11 12 13 14	Based on interview and record review, the facility did not comply with the section cited above. A child was left unattended and unsupervised, posing an immediate health, safety, or personal rights risk to children in care.	8 9 10 11 12 13 14	A proof of attendance from all staff will be required. The proof of attendance must be submitted to the department. The director stated she will also have the half door installed with an additional safety feature to prevent future incidents.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:

	Hanson Leong
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC809 (FAS) - (06/04)

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