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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004177
Report Date: 11/23/2021
Date Signed: 11/23/2021 12:17:36 PM

Document Has Been Signed on 11/23/2021 12:17 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LAUREL HEIGHTS CHILD DEVELOPMENT CENTER(INFANT)FACILITY NUMBER:
384004177
ADMINISTRATOR:PATZNER, KIMBERLEEFACILITY TYPE:
830
ADDRESS:2675 GEARY BLVD, SUITE 400TELEPHONE:
(415) 306-4730
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 33DATE:
11/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Joanne HaightTIME COMPLETED:
12:30 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
Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection today. LPA met with a Site Director, Joanne Haight, and explained the purpose of the inspection to her. There were 33 children with 13 staff present. The facility submitted an unusual incident report on 11/3/2021. It was about a child who was left alone in the center hallway on 10/26/21 during pick-up time. One of the parents saw the child alone in the hallway and reported it to the Business Manager. The manager located the child and took the child back to the classroom without any injury immediately. The child was left alone for about 1 to 2 minutes approximately.

* See the next page of the deficiency LPA cited during the inspection.*
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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 11/23/2021 12:17 PM - It Cannot Be Edited


Created By: Cindy Mok On 11/22/2021 at 02:43 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(INFANT)
FACILITY NUMBER: 384004177

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2021
Section Cited
CCR
101492(a)(1)

1
2
3
4
5
6
7
101492(a)(1) Responsibility for Providing Care and Supervision for Infants:
(a) In addition to Section 101229, the following shall apply: (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.
1
2
3
4
5
6
7
Facility required the involved staff to retrain in the "No Child Left Behind" & Transition Tracking policy & Supervision of Children (Indoor & outdoor). The faciltiy also form an in Service meeting to talk about Supervison with all staff. The facility updated the pick up and drop off policy to prevent the same incident.
8
9
10
11
12
13
14
This requirement was not met as evidenced by the unusual incident report. A child was left alone in the center hallway for about 1 to 2 minutes. It poses a potential health risk to children in care.
8
9
10
11
12
13
14
 LPA obtained a copy of the attendance record for the meeting and trainings,and the relevant documents of the trainings during the inspection. The deficiency was cleared during the inspection.

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:Ali Zebila
LICENSING EVALUATOR NAME:Cindy Mok
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2021


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