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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004176
Report Date: 04/16/2024
Date Signed: 04/16/2024 04:46:03 PM

Document Has Been Signed on 04/16/2024 04:46 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LAUREL HEIGHTS CHILD DEVELOPMENT CENTER(PS)FACILITY NUMBER:
384004176
ADMINISTRATOR/
DIRECTOR:		KRISTINA LANGNERFACILITY TYPE:
850
ADDRESS:2675 GEARY BLVD. SUITE 400TELEPHONE:
(415) 490-5204
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 110TOTAL ENROLLED CHILDREN: 110CENSUS: 75DATE:
04/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Director, Elizabeth Chrisman, and Assistant Director, Aamena Alloo TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On April 16, 2024 at approximately 1:45 PM, Licensing Program Analyst (LPA) Tso conducted an unannounced, case management visit. LPA met with program Director, Elizabeth Chrisman, and Assistant Director, Aamena Alloo and explained the purpose of the visit. Present in the facility is directors, 15 staff, and 75 children in care.

The case management visit is regarding an unusual incident that occurred on February 29, 2024. Facility self-reported incident to CCLD on March 07, 2024.

On February 29, 2024, a staff reported that a teacher (Teacher) redirected two children in the classroom by moved two children by putting the Teacher’s hand on the children’s upper arm. There were no injuries.

During today visit. LPA interviewed 3 staff including the Teacher. 2 staff stated that the Teacher putting the Teacher’s hand on the upper arm of a child in care to move them to the activities table in the classroom. This posed a potential risk to the health, safety or personal rights risks to the child(ren) in care. A Type B citation is issued for this deficiency this day. (See LIC809 D). During today visit, the Director demonstrated that the facility has already reviewed the personal rights of the children in care with all staff in March 2024. Hence, the deficiency citation is cleared at today visit.

An exit interview was conducted with the Director, Elizabeth Chrisman, and a plan of correction was discussed. A copy of this report with the appeal rights was discussed and provided, and the signature of this form acknowledges the receipt of these documents. A notice of site visit was given to the Director and must remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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 04/16/2024 04:46 PM - It Cannot Be Edited


Created By: Man Tso On 04/16/2024 at 04:29 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: LAUREL HEIGHTS CHILD DEVELOPMENT CENTER(PS)
FACILITY NUMBER: 384004176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2024
Section Cited
CCR
101223(a)(1)

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by:
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Director agrees to train staff on the person rights of the children in care, and email LPA agenda and a signature of all in attendance by 05/01/2024. During today visit, the Director demonstrated that the facility has already reviewed the personal rights of the children in care with all staff in March 2024. Hence, the deficiency citation is cleared at today visit.
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Based on interview and Incident report, staff witnessed a teacher putting the teacher’s hand on the child’s upper arm to move the child in care for moving them in the classroom, which poses/posed a potential risk to health, safety or personal rights risk to persons 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:Man Tso
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


LIC809 (FAS) - (06/04)
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