<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002982
Report Date: 05/30/2023
Date Signed: 05/30/2023 03:12:02 PM

Document Has Been Signed on 05/30/2023 03:12 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FRANDELJA FAIRFAXFACILITY NUMBER:
384002982
ADMINISTRATOR:COBBINS, CORNELLFACILITY TYPE:
850
ADDRESS:901 B FAIRFAX AVENUETELEPHONE:
(415) 822-1699
CITY:SFSTATE: CAZIP CODE:
94124
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 9DATE:
05/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Vernee PulliamTIME COMPLETED:
03:21 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 30, 2023, Licensing Program Analyst (LPA) Sheran Lo met with Lead Teacher Vernee Pulliam for Case Management Inspection to discuss the incident report received on April 10, 2023. Present is the Lead Teacher and 4 teachers caring for 9 children.

During today's inspection, LPA Lo discussed with Lead Teacher about the child left unsupervised in the outdoor play area for approximately 15-20 minutes on April 5, 2023 at 11:50AM. Lead Teacher states staff was written up by Administration, wrote in detail of what happened, and trained with additional steps to follow during transitions.


(Title 22, Division & Chapter number), is being cited on the attached LIC 809D.

LPA conducted exit interview with Lead Teacher. Report and Notice of Site Visit was provided.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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 2
Document Has Been Signed on 05/30/2023 03:12 PM - It Cannot Be Edited


Created By: Sheran Lo On 05/30/2023 at 10:28 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: FRANDELJA FAIRFAX
FACILITY NUMBER: 384002982

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2023
Section Cited
CCR
101229

1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary...(1) No child(ren) shall be left without the supervision of a teacher... Supervision... include visual..

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility will retrain staff and add additional steps to follow during transitions from outdoor to indoor areas.
8
9
10
11
12
13
14
Based on interviews, facility did not ensure to provide supervision at all times, which poses a potential Health, Safety, and Personal Rights risk to persons in care.
8
9
10
11
12
13
14
Staff involved attended individual training the same week. All Staff were trained as a group on April 28, 2023. Director will provided a copy of new transition protocol to LPA by end of today.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Sheran Lo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2