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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002696
Report Date: 04/02/2024
Date Signed: 06/04/2024 12:12:10 PM

Document Has Been Signed on 06/04/2024 12:12 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: 17DATE:
04/02/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Merve Perk, Rabab TawfikTIME COMPLETED:
03:35 PM
NARRATIVE
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THIS IS AN AMENDED REPORT TO REPORT DATED 4/2/2024.
On 4/2/2024 at 8:30AM., Licensing Program Analyst (LPA), Luis Gomez met with Lead Teacher, Merve Perek. The purpose of today’s inspection was an unannounced, 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 3 staff caring for 17 children. LPA inspected facility for health and safety hazards.

At 9:45AM., Based on record review, Interview and observations, LPA confirmed individual present (S1) without criminal record clearance or association on file. Per licensee, individual is present with children for interview and observation.
Amendment: deficiency and civil penalties dismissed.

At 11:00AM., Based on record review and interviews, LPA confirmed facility does not have a site director.
At 11:30AM., Based on record review, interview and observations, LPA confirmed facility fixtures, used for drinking water and food preparation, have not been tested for lead exceedance levels.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 1, 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.

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: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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Document Has Been Signed on 05/07/2024 04:10 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/15/2024 02:26 PM


Created By: Luis Gomez On 04/02/2024 at 10:27 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: 04/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/03/2024
Section Cited
CCR
101170(e)

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THIS IS AN AMENDED REPORT TO CHANGE CIVIL PENALTIES ISSUED ON 4/2/2024.
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 individual (S1) received criminal record clearance and facility association prior to presence in facility.
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At 9:45AM., Based on record review, interview and observations, LPA confirmed individual present (S1) without criminal record clearance or association on file. This poses an immediate health and safety risk to children in care.
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Facility was issued civil penalty of $100.00

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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2024


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Document Has Been Signed on 04/02/2024 03:26 PM - It Cannot Be Edited


Created By: Luis Gomez On 04/02/2024 at 10:42 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: 04/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/22/2024
Section Cited
CCR
101700(b)

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101700 (b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
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Licensee will ensure water outlets used for water ingestion or food preparation are tested for lead level exceedance by the due date: 4/22/2024.
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At 11:30AM., Based on record review, interview and observations, LPA confirmed facility fixtures, used for drinking water and food preparation, have not been tested for lead exceedance levels. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the Department via email.
Request Denied
Type B
04/22/2024
Section Cited
CCR101215.1(b)

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101215.1(b) All child care centers shall have a director. This requirement was not met as evidence by:
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Licensee will hire a site director by the due date: 4/22/2024.
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At 11:00AM., Based on record review and interviews, LPA confirmed facility does not have a site director. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the department via email.
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: 04/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2024


LIC809 (FAS) - (06/04)
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