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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003047
Report Date: 09/26/2023
Date Signed: 09/26/2023 04:43:12 PM

Document Has Been Signed on 09/26/2023 04:43 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:UNIVERSITY CHILD CARE AT MISSION BAY (PS)FACILITY NUMBER:
384003047
ADMINISTRATOR:CAHILL, MEGANFACILITY TYPE:
850
ADDRESS:727 NELSON RISING LANETELEPHONE:
(617) 673-8000
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY: 206TOTAL ENROLLED CHILDREN: 184CENSUS: 203DATE:
09/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Sandra HilliardTIME COMPLETED:
04:47 PM
NARRATIVE
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C1 = Child 1

On Septmber 26, 2023 at approximately 3:30 PM, Licensing Program Analyst (LPA) Cowan conducted an unannounced, case management visit. LPA met with Executive Director, Sandra Hilliard, and explained the purpose of the visit. Present in the facility is directors, 50 staff, and 203 children in care.

The case management visit is regarding an unusual incident that occurred on September 15, 2023. Facility self reported incident to CCLD on September 20, 2023.

On September 15, 2023, in the morning, Staff was leaving the yard to make an emergency call to parents of another child. Just before leaving, C1 asked to go to the restroom. Staff took child to the restroom and made the necessary call. Staff forgot child was in the restroom and returned to yard. Incident report states that as soon as staff returned to the yard, staff remembered child in the bathroom. Staff returned to the bathroom to find child still there. Staff waited for child to finish in the restroom and they both returned to the yard.

Executive director states that child was alone for about one minute before staff returned to get child. This is a potential risk to children in care. A Type B citation is issued for this deficiency this day.


Exit interview conducted and report was and plan of correction reviewed with the executive director, Sandra Hilliard.

A notice of site visit was given and must remain posted for 30 days.



>See next page for deficiencies
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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 09/26/2023 04:43 PM - It Cannot Be Edited


Created By: April Cowan On 09/26/2023 at 04:25 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: UNIVERSITY CHILD CARE AT MISSION BAY (PS)
FACILITY NUMBER: 384003047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.(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.
This requirement was not met as evidenced by:
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Executive director agrees to train staff on proper supervision and email LPA agenda and a signature of all in attendance by 10/02/23.
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Based on interview and Incident report, staff left a child alone without supervision in the bathroom for at least one minute. This is a potential 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:Garfield Leung
LICENSING EVALUATOR NAME:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


LIC809 (FAS) - (06/04)
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