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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002696
Report Date: 05/07/2024
Date Signed: 05/07/2024 04:19:24 PM

Document Has Been Signed on 05/07/2024 04:19 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/
DIRECTOR:		OUELLETTE, JOYFACILITY TYPE:
850
ADDRESS:610-A CORTLAND AVENUETELEPHONE:
(415) 722-7476
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 17DATE:
05/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Rabab TawfikTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On 5/7/2024 at 12:30PM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Rabab Tawfik. The purpose of today’s inspection was an unannounced, complaint inspection. This case management report is to cited facility for deficiencies found during inspection. Present were 5 staff caring for 17 children. LPA inspected facility for health and safety hazards.

At 12:45PM., Based on observation and interview, LPA confirm child (C9) placed inside play pen, during scheduled lunch time.
At 1:25PM., Based on record review and interviews, LPA confirmed facility does not have a site director.
At 1:30PM., Based on record review and interview, LPA confirmed facility fixtures, used for drinking water and food preparation, have not been tested for lead exceedance levels.
At 1:50PM., Based on record review, interview and observations, LPA confirmed present staff member’s file (S1) missing from facility records.
At 2:55PM., Based on observation, LPA confirmed napping children left without staff supervision.

During inspection, LPA provided licensee with PIN21-21 CCP, regarding requirement and written directives for all childcare centers to perform lead testing on all water outlets used for ingestion or food preparation. License was encouraged to visit Department website:
https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

During inspection, LPA provided staff with LIC311A, Records to be maintained in childcare center.
During inspection, LPA provided staff with Title 22 code of regulations, Childcare Center Director Qualifications.

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, Plans for Correction, and Report was reviewed with Licensee, Rabab Tawfik. Staff'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)
Page: 1 of 4
Document Has Been Signed on 05/07/2024 04:19 PM - It Cannot Be Edited


Created By: Luis Gomez On 05/07/2024 at 02:13 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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
101223(a)(2)

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101223(a)(2) Personal Rights. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Licensee will submit behavior plan for child, showing appropriate behavior intervention strategies by the due date: 5/10/2024.
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At 12:45PM., Based on observations and interview, LPA confirm child (C9) placed inside napping play pen during scheduled lunch time. 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.
Type B
05/14/2024
Section Cited
CCR101215.1(b)

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(b) All child care centers shall have a director. This requirement was not met as evidenced by:
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Licensee will hire fully qualified site director by the due date: 05/14/2024.
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At 1:25PM., 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: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/07/2024 04:19 PM - It Cannot Be Edited


Created By: Luis Gomez On 05/07/2024 at 02:20 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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2024
Section Cited
CCR
101700(b)

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101700(b) Written Directives: 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 have water outlets, used for drinking water tested for lead level exceedance by the due date: 05/14/2024.
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At 1:30PM., Based on record review and interview, 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 department vai email.
Type B
05/14/2024
Section Cited
CCR101217(c)

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101217(c) Personnel Records. All personnel records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. This requirement was not met as evidence by:
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Licensee will have all staff files in facility, ready for Department review by the due date: 5/14/2024.
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At 1:50PM., Based on record review, interview and observations, LPA confirmed present staff member’s file (S1) missing from facility records. 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.
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: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/07/2024 04:19 PM - It Cannot Be Edited


Created By: Luis Gomez On 05/07/2024 at 03:02 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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2024
Section Cited
CCR
101229(a)

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101229(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. The requirement was not met as evidenced by:
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Licensee will submit staff schedule (LIC500) and classroom assignments, showing constant supervision at all times. Proof of correction will be submitted will be submitted to Department by due date: 5/13/2024 via email.
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At 2:55PM., Based on observations, LPA confirmed napping children left alone without staff supervision. This poses a potential health and safety risk to children in care.
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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: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
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