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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002350
Report Date: 09/22/2023
Date Signed: 09/22/2023 12:44:25 PM

Document Has Been Signed on 09/22/2023 12:44 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:UCSF KIRKHAM CDC (PS)FACILITY NUMBER:
384002350
ADMINISTRATOR:CHONA ROBERTO-CHENGFACILITY TYPE:
850
ADDRESS:10 KIRKHAM STREETTELEPHONE:
(415) 664-1217
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94143
CAPACITY: 93TOTAL ENROLLED CHILDREN: 93CENSUS: 66DATE:
09/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Catherine Trabanino & Chona Roberto-ChengTIME COMPLETED:
01:00 PM
NARRATIVE
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On September 22, 2023, at approximately 11:30am, Licensing Program Analyst (LPA) Ly conducted a Case Management Visit. This facility self reported an incident that a child was left unattended in the classroom for less than 3 minutes. LPA met with Facility's Regional Manager Catherine Trabanino and Center Director Chona Roberto-Cheng. Present during today's visit were 24 staff including the Director caring for 66 children.

Per incident report submitted to CCLD, the classroom was transitioning to the playground, a child was left in the classroom. When the staff realized child was not with the group, child was found safe in the classroom. Parent of child was notified of the incident. Involved staff was put on Administrative Leave.

Based on the information gathered, it was determined there was a lack of supervision, type B deficiency was cited today in accordance with the California Code of Regulations, Title 22, see LIC 809D.

During today's visit, Regional Manager submitted an agenda for facility Professional Development Day and one of topics involved in Tracking & Supervision. This deficiency is considered corrected and cleared as of today.

A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to Director. Letter of Deficiency Cleared also provided to the Director.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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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Document Has Been Signed on 09/22/2023 12:44 PM - It Cannot Be Edited


Created By: Winnie Ly On 09/22/2023 at 12:21 PM
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: UCSF KIRKHAM CDC (PS)
FACILITY NUMBER: 384002350

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a)The licensee shall provide care and supervision as necessary to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).Supervision shall include visual observation.
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The Facility Representative immidiately took action by putting the involved staff on administrative leave. Facility will also host a Professional Developement Day and one of the training topics will be "Tracking & Supervision."
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This requirement is not met as evidenced by confirmation that a lack of supervision had occurred on September 7, 2023 where a child was not accounted for and was found in the classrom alone for less than 3 minutes, this poses an immediate health and safety risk to the child in care.
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This deficiency is considered corrected and cleared as of today.

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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:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023


LIC809 (FAS) - (06/04)
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