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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004114
Report Date: 08/18/2023
Date Signed: 08/18/2023 03:43:00 PM

Document Has Been Signed on 08/18/2023 03:43 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:STUDIO MONTESSORI, LLC (PS)FACILITY NUMBER:
384004114
ADMINISTRATOR:CHOI, HANNAHFACILITY TYPE:
850
ADDRESS:633 8TH STREETTELEPHONE:
(415) 510-1287
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY: 31TOTAL ENROLLED CHILDREN: 31CENSUS: 11DATE:
08/18/2023
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Hahhah ChoiTIME COMPLETED:
03:57 PM
NARRATIVE
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On August 18, 2023 at approximately 2:00 pm, Licensing Program Analyst (LPA) Cowan conducted an announced, case management visit. LPA met with site director Hannah Choi and explained the purpose of the visit. Present in the facility is director, 1 staff, and 11 children in care. The case management visit is regarding an unusual incident that occurred on June 28, 2023. Licensee, Zoe Paul, self reported incident to CCLD on June 29, 2023.
At approximately 12:15 pm, a child was found to be missing during lunch time at the building courtyard. T1, T3, and director were present at the time. Director states that she believes the child exited the group during a transition from the courtyard bench to children sitting at the lunch table. Per director, Child exited the courtyard, through the Brannon St. door, and child headed toward the school when child was found by a security guard from the neighboring Air B n B company located across the street. Per director, one guard waited with child at the nearby pizza cafe while another guard went to the facility to see if the child belonged in care there. The child was retrieved by T2.

Per director, child's parents were informed of incident on the morning of June 29, 2023, and an email went out to all parents reporting the incident as well as inviting them to a Zoom meeting held on June 30, 2023 to discuss the incident.



A plan of correction was discussed with site director. Additional safety protocols were implemented by site director. Director states that licensee is preparing training for staff, but until then, staff are doing more frequent head count using name to face, staff are taking out smaller groups of children, and staff are writing down the names of children they are supervising outdoors.


Report Continues .....
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: STUDIO MONTESSORI, LLC (PS)
FACILITY NUMBER: 384004114
VISIT DATE: 08/18/2023
NARRATIVE
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Based on interviews and licensee self-reporting, a child left its group while away from the facility resulting in an absence of supervision. This is an immediate risk to children in care and a Type A citation is issued for this deficiency. Also, an immediate civil penalty has been cited under H&S 1597.58(c)(2). Please refer to 809D for more information. An office meeting will be scheduled to discuss incident.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Cowan informed director, Hannah Choi, that this report dated August 18, 2023 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Cowan informed the director to provide a copy of this licensing report dated August 18, 2023 that documents any Type A citation to parents/guardian of all children enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with site director, Hannah Choi.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
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Document Has Been Signed on 08/18/2023 03:43 PM - It Cannot Be Edited


Created By: April Cowan On 08/18/2023 at 03:11 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: STUDIO MONTESSORI, LLC (PS)
FACILITY NUMBER: 384004114

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2023
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 me as evidenced by:
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Site director agrees to train staff regarding close supervision of children by August 25, 2023. Licensee and or site director must attend an Office Meeting conducted by Regional office.
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Based on interview with licensee and site director, a child was without supervision when child left its group at the courtyard. This is an immediate 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: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023


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