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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002696
Report Date: 04/17/2023
Date Signed: 04/17/2023 04:01:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2023 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230222125838

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:20CENSUS: 14DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Rabab TawfikTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff are not adequately trained on incidental medical care.
INVESTIGATION FINDINGS:
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On 4/17/2023 at 1:20PM., Licensing Program Analyst (LPA) Luis J. Gomez met with Licensee, Rabab Tawfik. Purpose of the inspection was explained and was for an unannounced, complaint investigation. Present was licensee and three staff caring for 14 children. LPA inspected facility for health and safety hazards.

During inspection, LPA performed site observations, interviews and reviewed facility records. At 2:30PM, Based on record review and interview, LPA confirmed facility does not have a site director. Per licensee, director will be hired by next month (May, 2023). Advisory Note: Techncial Violation (LIC9102TV) was issued.

During the course of the investigation, observations were conducted on 3/3/2023 and 4/17/2023. A review of the facility records was complete, which included staff's files, children’s files, and children’s roster (LIC9040). LPA conducted interviews with staff, licensee, parents and involved parties.
(REFER TO LIC9099C, FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 05-CC-20230222125838
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696
VISIT DATE: 04/17/2023
NARRATIVE
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(Page 2)
Regarding the allegation staff are not adequately trained on incidental medical care; Based on record review and interviews conducted, LPA confirmed staff's CPR/ First Aid certification has expired.

Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) are being cited on attached 9099D. Appeal Rights were provided to licensee.

Notice of site visit was provided and must remain posted for 30 days. This report will be kept in the facility file and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 05-CC-20230222125838
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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: 04/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2023
Section Cited
HSC
1596.886
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§1596.866. Additional health and safety training; condition of licensure. (a) (1) In addition to other required training, at least one director or teacher at each day care center, and each family day care home licensee who provides care, shall have at least 15 hours of health and safety training, and if applicable, at least one additional hour of training pursuant to clause (ii) of subparagraph (C) of paragraph (2). This requirement was not met as evidenced by.
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Licensee will ensure present staff member, has current CPR/ First Aid certifications at all times. Updated personnel roster/ schedule, LIC500, will be submitted to the department by due date: 4/26/2023.
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Based on record review and interviews conducted, LPA confirmed staff's CPR/ First Aid certification has expired. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted 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.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5