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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004643
Report Date: 06/05/2024
Date Signed: 06/05/2024 01:46:51 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
05/10/2024 and conducted by Evaluator Man Tso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240510113737
FACILITY NAME:POTRERO HILL MONTESSORI SCHOOLFACILITY NUMBER:
384004643
ADMINISTRATOR:YANG, LIUFACILITY TYPE:
850
ADDRESS:1701 17TH STREETTELEPHONE:
(650) 476-3015
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:54CENSUS: 19DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:(Jessica) Liu YangTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Uncleared Adult
INVESTIGATION FINDINGS:
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On June 05, 2024, at approximately 8:40 AM, Licensing Program Manager (LPM ) Leung and Licensing Program Analyst (LPA), Tso made an unannounced complaint investigation and met with the Administrative assistant, (Sam) Jie Kun Liu. (The Director, (Jessica) Yang Liu was not at the facility until approximately 10.00am). Purpose of the visit was explained. Present in the facility is Director, 6 teachers, and 19 children in the toddler classrooms. During the inspection, interviews were conducted with the Director and staff.

During the course of the investigation, interviews were conducted with staff members and relevant documents were gathered. Based on the interviews, observation, and record review, there was no sufficient evidence to prove that the allegation listed above, occurred. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted and this report was reviewed with the Director whose signature confirm have read the report. Report must be made available for public review upon request. A copy of this report and appeal rights have been discussed and left with Director. Notice of Site Visit shall remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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
05/10/2024 and conducted by Evaluator Man Tso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240510113737

FACILITY NAME:POTRERO HILL MONTESSORI SCHOOLFACILITY NUMBER:
384004643
ADMINISTRATOR:YANG, LIUFACILITY TYPE:
850
ADDRESS:1701 17TH STREETTELEPHONE:
(650) 476-3015
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:54CENSUS: 19DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:(Jessica) Liu YangTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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2
3
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9
Staff are operating out of ratio
INVESTIGATION FINDINGS:
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On June 05, 2024, at approximately 8:40 AM, Licensing Program Manager (LPM ) Leung and Licensing Program Analyst (LPA), Tso made an unannounced complaint investigation and met with the Administrative assistant, (Sam) Jie Lun Liu. (The Director, (Jessica) Yang Liu was not at the facility until approximately 10.30am). Purpose of the visit was explained. Present in the facility is Director, 6 teachers, and 19 children in the toddler classrooms. During the inspection, interviews were conducted with the Director and staff.

Based on LPA’s gathered information through observation, interviews and records reviews, the agency has investigated the complaint allegation above. The facility did not comply with the Teacher-Child Ratio regulations when the children doing outdoor activities. The preponderance of evidence standard has been met. The above allegation is found to be SUBSTANTIATED. A Type B violation was issued today, June 5, 2024 in accordance with the California Code of Regulations, Title 22, Division 12 & Chapter 3, citation was being cited on the attached LIC 9099D.

Exit interview conducted and a copy of this report and appeal rights were discussed and left with the Director, Jessica Yang, whose signature on this form confirms receipt of these reports. Notice of Site Visit (The Notice) was provided. The Notice is to remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20240510113737
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: POTRERO HILL MONTESSORI SCHOOL
FACILITY NUMBER: 384004643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2024
Section Cited
CCR
101216.3(a)2
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101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. (2) Whenever children are engaged in activities away from the center, no teacher shall be in charge of a group of more than 12 children.

This requirement is not met as evidenced by:
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The Director would provide the plan of corrections to meet the teacher and children ratio at all time on or before June 19, 2024.
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Based on observation, interviews and record review, the facility did not comply with the waiver requirements issued by the Department. Sometimes, the facility operates out of ratio at the park, which posed a potential 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.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3