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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002794
Report Date: 08/09/2023
Date Signed: 08/09/2023 04:29:27 PM

Document Has Been Signed on 08/09/2023 04:29 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LITTLE TRAILBLAZERS (PS)FACILITY NUMBER:
384002794
ADMINISTRATOR:HOM, SONDRAFACILITY TYPE:
850
ADDRESS:50 FREMONT STREETTELEPHONE:
(650) 484-3000
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94105
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 15DATE:
08/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:12 PM
MET WITH:Sondra HomTIME COMPLETED:
04:30 PM
NARRATIVE
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On 8/9/2023, Licensing Program Analysts (LPAs), Leong and Van, made an unannounced case management visit to the child daycare facility listed above. The purpose of today's visit was to follow up on an incident regarding personal rights that occurred on 7/27/2023. The LPAs were granted entry by the Director, Sondra Hom. The LPAs explained the purpose of the visit to the Director. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPAs observed three staff members supervising fifteen preschool aged children. Children's capacity and ratio requirements were observed to be in compliance.

During today’s visit, both LPAs discussed the importance of personal rights regarding children in care. The LPAs will require the Director to go over personal rights with that particular individual. To correct the incident that took place on 7/27/2023, a plan of correction must be developed and submitted to the department. The facility will be assessed a Type B violation because of the incident that occurred on 7/27/2023. The LPAs collected and reviewed pertinent documents regarding personal rights training for that particular individual

Please refer to LIC 809D for today’s citation.

***The department may clear all violations after the review of the facilities’ Plan of Correction***

A copy of today’s report, the “Notice of Site Visit” their appeal rights were given to Sondra Hom. A “Notice of Site Visit” must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted, and the report was reviewed with Sondra Hom
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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 08/09/2023 04:29 PM - It Cannot Be Edited


Created By: Hanson Leong On 08/09/2023 at 03:15 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 TRAILBLAZERS (PS)
FACILITY NUMBER: 384002794

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2023
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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The Director will provide training material regarding personal rights to the department . The due date will be 8/16/2023.
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Based on interview and record review, the licensee did not comply with the section cited, which poses a potential health, safety or personal rights 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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Hanson Leong
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


LIC809 (FAS) - (06/04)
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