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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004405
Report Date: 07/24/2024
Date Signed: 07/24/2024 01:48:25 PM

Document Has Been Signed on 07/24/2024 01:48 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 SCHOOLFACILITY NUMBER:
384004405
ADMINISTRATOR/
DIRECTOR:		NANCY LAMBERT-CAMPBELLFACILITY TYPE:
850
ADDRESS:2110 GREENWICH STREETTELEPHONE:
(415) 749-3551
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94123
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 28DATE:
07/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Principal, Nancy Lambert-CampbellTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 7/24/2024, at approximately 12:50PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced case management visit at the facility. LPA met with Director Nancy Lambert-Campbell (D1) and explained the purpose of the visit., which was to follow up on a self-reported incident. Present during the visit was D1, four teachers, and 28 preschool age children. The facility is in compliance with staffing and ratio requirements on this day.

The facility self-reported an incident that occurred on 7/17/2024 where a child (C1) was without visual supervision by teachers for approximately 10 minutes. C1 was in the outdoor play area and left the play structure area. C1 did not leave the facility premises. LPA conducted site observations and reviewed video footage of the incident during the visit. Based on site observations and video footage review, a violation of CCR 101229(a)(1) did occur at the facility, where a child was without visual supervision. LPA informed D1 that a Type B deficiency would be cited today.

D1 stated that they spoke with all teachers regarding transition procedures and placement of staff during outdoor play to ensure that there is constant supervision at all times. D1 provided LPA with an email correspondence that was signed by all teachers present during today's visit. D1 had provided teachers with guidance on how to ensure visual supervision at all times. Teachers had signed the correspondence, providing acknowledgement of how to provide supervision moving forward. The facility has taken appropriate steps to ensure the incident does not occur again.

See LIC809-D for deficiency cited today regarding supervision of children in care. The deficiency shall be cited and cleared the same day of the visit, 7/24/24. Appeal rights were provided and explained to D1. A notice of site visit was given and must be posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Nancy Lambert-Campbell.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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 07/24/2024 01:48 PM - It Cannot Be Edited


Created By: Jonathan Tse On 07/24/2024 at 01:34 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: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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D1 had discussed supervision and transition policies with involved staff. All staff at the facility were notified of best practices regarding supervision. Staff present during the incident have signed and acknowledged directions provided by D1.
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Based on interview, record review, and observation, the licensee did not comply with the above by having one child without the visual supervision of a teacher, which posed a potential health, safety, or personal rights risk to persons in care.
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The facility has taken appropriate measures to address the incident and reinforced guidelines on best practices.

This deficiency shall be cited and cleared the same day of the visit, 7/24/2024.

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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:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
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