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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002696
Report Date: 03/05/2024
Date Signed: 09/11/2024 12:37:23 PM

Document Has Been Signed on 09/11/2024 12:37 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:LITTLE ANGELS NURSERY SCHOOLFACILITY NUMBER:
384002696
ADMINISTRATOR:OUELLETTE, JOYFACILITY TYPE:
850
ADDRESS:610-A CORTLAND AVENUETELEPHONE:
(415) 722-7476
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 16DATE:
03/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rabab TawfikTIME COMPLETED:
12:30 PM
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***THIS IS AN AMENDED REPORT ORIGINALLY DATED 03/05/24****

On 3/5/2024 at 8:30AM., Licensing Program Analysts (LPA), Luis Gomez met with Lead Teacher, Carmen Villon The purpose of today’s inspection was an unannounced, 10-day complaint inspection. This case management report is to cited for deficiencies found during inspection. Licensee, Rabab Tawfik arrived during inspection. Present was the lead teacher and 2 staff caring for 16 children. LPA inspected facility for health and safety hazards.

At 8:50AM., Based on observations, LPA confirmed hazardous objects inside drawer in accessible kitchen area.
At 10:00AM., Based on record review and observations, LPA confirmed staff (S1) present without criminal record clearance or association.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations and cited on 809D. Exit interview, Plan for Correction, and Report was reviewed with Licensee, Rabab Tawfik. Licensee’s signature of this form acknowledges the receipt of these documents.

Licensee was issued Type “B” deficiency.

Civil Penalty was issued to facility for $300.00.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Carol Marcroft
LICENSING EVALUATOR NAME: Cindy Interiano
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 09/11/2024 12:37 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/11/2024 12:31 PM


Created By: Cindy Interiano On 03/05/2024 at 11:40 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/06/2024
Section Cited
CCR
101170(e)

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***THIS IS AN AMENDED REPORT ORIGINALLY DATED 03/05/24***

101170(e) Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
This requirement was not met as evidenced by:
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Licensee will ensure staff member (S1) receives criminal record clearance and association prior to present in facility.

Proof of correction will be submitted to the department via email.
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At 10:00AM., Based on record review and observations, LPA confirmed staff (S1) present without full criminal record clearance or association. This poses a potential health and safety risk to children in care.
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Civil Penalty issued during inspection for: $300.00.

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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:Carol Marcroft
LICENSING EVALUATOR NAME:Cindy Interiano
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024


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Document Has Been Signed on 03/05/2024 12:40 PM - It Cannot Be Edited


Created By: Luis Gomez On 03/05/2024 at 11:46 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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/08/2024
Section Cited
CCR
101238(g)

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101238(g) Building and Grounds. (g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met as evidenced by:
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Licensee will install safety lock on drawer or/ make kitchen area inaccessble by the due date: 3/8/2024.
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At 8:50AM., Based on observations, LPA confirmed hazardous objects inside drawer in accessible kitchen area. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to department via email.

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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024


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