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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002696
Report Date: 05/23/2024
Date Signed: 05/29/2024 02:34:49 PM

Document Has Been Signed on 05/29/2024 02:34 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: 16DATE:
05/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Carmen Villion Chirinos & Rabab TawfikTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
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On May 23, 2024 @ approx. 9:25am Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced Case Management visit. LPA arrived at facility and called phone number listed. Owner Rabab Tawfik answered and stated children were at the park and owner would arrive in a few minutes. LPA walked to the park and met with Teacher Carmen Villion Chirinos and teacher assistant, supervising 10 children. LPA returned to facility where there were two staff supervising 4 children. Owner arrived at @ 10:00 and LPA explained the purpose of the visit.

The purpose of the visit was to follow up on a self reported unusual incident report that happened on May 17, 2024. Incident involved absence of supervision, as a child walked away from park and was found down the street by a city worker. Per owner, as she was looking for child, she saw a child with a red shirt and a man stand down the street. Owner immediately went down the street, where the child was with the city worker. Per staff, C1 was missing for approx. 4-6 minutes. After the incident, the facility had an all staff training on supervision and owner had a meeting with the child’s family.

Based on interviews conducted today and the incident report received on May 17, 2024, it was determined that supervision was absent when the child left the park alone and was found down the street. Staff have no knowledge how child was able to walk out of park through gate unseen.

As a result of today's visit, A Type "Deficiency for absence of supervision is cited on the following 809-D page and an immediate $500 civil penalty was assessed for the absence of supervision.

Type “A” violation was issued today. Licensee/Owner Rabab Tawfik was advised to provide a copy of the Facility Evaluation Report and the Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

Exit interview was conducted and report was reviewed with Licensee/Owner Rabab Tawfik over phone and Carmen Villion Chirinos. A copy of this report will be emailed to rtawfik1970@gmail.com by the end of day.

Notice of site visit shall be posted and shall remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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 05/29/2024 02:34 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 05/23/2024 at 11:42 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: 05/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2024
Section Cited
HSC
1596.99(c)(3)

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1596.99 Levy of civil penalty in addition to suspension, temporary suspension, or revocation; amounts; regulations setting forth appeal procedures for deficiencies
(c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations: (3) Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.


This requirement is not met as evidenced by:
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Per Owner, facility has changed park visits to smaller ratios and older group with visit park from 9-11am. and younger group will visit park from 10:45-11:45am. Owner conducted a staff meeting on 05/20/2024 to review supervision protocol. Owner will submit agenda of what was discussed, along with signature of staff acknowledging agenda discussed.
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Based on record review and interviews conducted today, it was determined a child walked away from the park and was found down the street unsupervised by staff, which poses an immediate health, safety or personal rights risk to persons in care.
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Incident will be discussed during office meeting on June 4, 2024.

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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:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024


LIC809 (FAS) - (06/04)
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