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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004285
Report Date: 11/15/2023
Date Signed: 11/15/2023 12:53:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/09/2023 and conducted by Evaluator Cindy Mok
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20231109081850
FACILITY NAME:JUST KIDS PRESCHOOLFACILITY NUMBER:
384004285
ADMINISTRATOR:XIE, SANDYFACILITY TYPE:
850
ADDRESS:5727 GEARY BLVD.TELEPHONE:
(415) 418-6676
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:24CENSUS: 19DATE:
11/15/2023
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Sandy XieTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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A staff lifted a child in an improper way that caused a child's arm injury.
INVESTIGATION FINDINGS:
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LPA Mok conducted an unannounced complaint inspection today. LPA met with a Site Director, Sandy Xie, and explained the purpose of the Inspection to her. The facility had 19 children with 3 staff present. LPA interviewed staff and obtained the relevant information from the facility during the Inspection.


Based on the information CCL gathered, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 9099D.”)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 05-CC-20231109081850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JUST KIDS PRESCHOOL
FACILITY NUMBER: 384004285
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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The director will conduct an expectations meeting with a particular staff on 11/16/23 and a training on The Proper way to Handle Children with all staff on 11/17/23. Training Material and attendance sheet with staff signatures for the training will be sent to LPA by 11/22/2023.
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This requirement was not met as evidence based upon the information CCL gathered; a staff lifted a child in an improper way that caused a child's arm injury. It poses a potential health 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.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2