384004405-9-12-2025-05-CC-RWAA-DLFRRZ-20250912131557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004405
Report Date: 09/12/2025
Date Signed: 09/12/2025 01:16:21 PM

Document Has Been Signed on 09/12/2025 01:16 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:	SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL		FACILITY NUMBER:	384004405
ADMINISTRATOR/ DIRECTOR:	NANCY LAMBERT-CAMPBELL		FACILITY TYPE:	850
ADDRESS:	2110 GREENWICH STREET		TELEPHONE:	(415) 749-3551
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94123
CAPACITY: 96	TOTAL ENROLLED CHILDREN: 52	CENSUS: 48	DATE:	09/12/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Nancy Lambert - Campbell		TIME VISIT/ INSPECTION COMPLETED:	01:30 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	On 9/12/2025, Licensing Program Analysts (LPAs) Wadhwa and Ly conducted an unannounced annual visit in conjunction with a case management visit for a self reported incident reported to the department on 8/25/2025. LPAs met with Director, Nancy Lambert-Campbell and explained the purpose of the visit. The facility operates Monday through Fridays 7:30 AM to 5:30 PM. The facility is currently operating out of classroom #1, 2, 3, 4. Present during today’s visit are the Director, 12 staff and 48 preschool children. The facility is operating within capacity and ratio requirements on this day. Parents are required to sign in and sign out using wet signatures daily. The facility license, Child Passenger Restraint System Poster, Notifications of Parents’ Rights, Emergency Disaster Plan, and Personal Rights were displayed on the bulletin board. The last emergency disaster drill was conducted on 9/11/2025, and documented in the facility log. A review of previous drills confirmed that emergency drills are conducted every month. The facility is equipped with multiple smoke and carbon monoxide detectors, multiple fully charged fire extinguishers, and multiple first aid – supply kits. A fire alarm system runs throughout the facility. The facility was constructed after January 1, 2010, and as such is exempt from lead testing requirements. The facility was found to be clean, well maintained, and free from hazards. Disinfectants, cleaning solutions, and toxic substances were inaccessible to the children. All accessible cabinets and drawers in the classrooms contained no hazardous materials. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL	FACILITY NUMBER: 384004405
	VISIT DATE: 09/12/2025

NARRATIVE

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The facility provides a food service Monday through Fridays including a breakfast, a hot lunch and two snacks. Per Director, all food is provided by school district and supplied to the facility daily. Allergy lists were found to be appropriately displayed in the cafeteria. Children bring their own water bottles which are labeled and are refilled from a non-contaminating source as needed.

The facility provides cots and sheets for napping, for the children in care. The facility requires parents to supply bedding for their children, which is returned on a weekly basis for laundering.

The facility is equipped with age-appropriate toys, furniture, and learning materials. Each child has an individual cubby labeled with their name. Each classroom has two toilets and two sinks in the children’s bathroom. The bathroom area is clean, fully operational, and equipped with essential sanitation supplies.

The outdoor playground is fully enclosed with a fence at least 4 feet tall. No pools, spas, or bodies of water were present on the property. LPAs observed the play structure to be cushioned with resilient padding. There is natural shade available from facility buildings and trees.

LPAs reviewed six staff files and found valid certificates for Pediatric First Aid/CPR and Mandated Reporter Training.
LPAs reviewed eight children’s files and found them to be complete, including all required licensing forms. LPAs observed two children's files with medical history of "Asthma" with medication required but facility did not have medication for both children on site. Per Director, parents were reminded a few times to provide medication. A technical violation has been issued. See LIC9102TV

On this day, LPAs also conducted a case management that was related to a self-reported incident to the department that occurred at the facility on 8/25/2025 at 11:45AM in Classroom #1. At the time, there were three staff and 11 children present. Per staff, the class transitioned from the classroom to the cafeteria at 11:45 AM and approximately 25 minutes later staff realized one child was missing. The staff immediately notified the Director and began searching for the child. The child was located by the Director at 12:24 PM hiding under the red chairs in the reading nook of Classroom #1. Per Director, the child was not crying or showing any signs of distress.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025

LIC809 (FAS) - (06/04)

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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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL	FACILITY NUMBER: 384004405
	VISIT DATE: 09/12/2025

NARRATIVE

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The Director stated there was an internal investigation and multiple one-on-one discussions conducted since to reinforce the importance of maintaining continuous supervision. LPAs have issued a Type A citation for absence of supervision and discussed the plan of correction with the Director.

Based on interviews and record review conducted today, a Type A violation has been issued for absence of supervision in accordance with the Title 22 Division 12 of California Code of Regulations. See LIC 809D.
LPAs informed Director, Nancy Lambert-Campbell that this report dated 9/12/2025 documenting Type A citation(s) shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs informed the Director to provide a copy of this licensing report (9/12/2025) that documents any Type A citation(s) to parents/guardians of all children currently 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 (LIC9224), or other written statement, must be placed in the child’s file for verification.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS.For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025

LIC809 (FAS) - (06/04)

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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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL	FACILITY NUMBER: 384004405
	VISIT DATE: 09/12/2025

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Please see LIC 809-D for deficiencies cited today.

A copy of this report with the appeal rights was provided, and signature of this form acknowledges the receipt of these documents.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Nancy Lambert-Campbell.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Ruhi Wadhwa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/12/2025 01:16 PM - It Cannot Be Edited

Created By: Ruhi Wadhwa On 09/12/2025 at 12:29 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: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL	FACILITY NUMBER: 384004405
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101229(a)(1)

101229 Responsibility for Providing Care and Supervision (a) (1) No child(ren) shall be left without the supervision of a teacher at any time. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interviews conducted a preschool child was left unattended and unsupervised by staff for approximately 40 minutes which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/12/2025
	Plan of Correction
1 2 3 4	Director will provide a written POC by POC due date 10/12/2025 documenting corrective actions undertaken by the facility to ensure supervision is continious. The written POC will include but not be limited to actions undertaken such as immediate changes in supervision protocols, trainings conducted with staff, reprimands for staff involved and reorganization of classroom to ensure any obstruction to supervision is removed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:

	Ruhi Wadhwa
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025

LIC809 (FAS) - (06/04)

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