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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004176
Report Date: 11/01/2024
Date Signed: 11/01/2024 12:46:44 PM

Document Has Been Signed on 11/01/2024 12:46 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: 92CENSUS: 80DATE:
11/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:48 AM
MET WITH:Kristina LangnerTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On November 01, 2024 at approximately 8:45 AM, Licensing Program Analyst (LPA) Tso conducted an unannounced, case management visit. LPA met with Director, Kristina Langner, and explained the purpose of the visit. Present in the facility is director, assistant director, 12 staff, and 80 children in care.

The case management visit is regarding an unusual incident that occurred on October 15, 2024. Facility self-reported incident to CCLD on October 22, 2024.

On October 15, 2024, a parent communicated to the facility Director that a child (C1) stated that when a staff (S1) took S1’s finger and shoved it to the throat of C1.

According to the interviews with the director, 2 staff and 2 children and the information obtained, the facility did not comply with the children’s personal rights regulations. This posed a potential risk to the health, safety or personal rights risks to the person in care. A Type B citation is issued for this deficiency this day. (See LIC809 D).

An exit interview was conducted with the Director, Kristina Langner, 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: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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 11/01/2024 12:46 PM - It Cannot Be Edited


Created By: Man Tso On 11/01/2024 at 12:14 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: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2024
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.

This requirement was not met as evidenced by:
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Director agrees to train staff on upholding children’s personal rights and email LPA agenda and a signature of all in attendance by 11/15/2024.
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Based on interviews with the director, 2 staff, 2 children and the information obtained that a staff took their finger and shoved it to the throat of a child in care, 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: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
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