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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410503100
Report Date: 03/28/2025
Date Signed: 03/28/2025 01:39:58 PM

Document Has Been Signed on 03/28/2025 01:39 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:PHILLIPS BROOKS NURSERY SCHOOLFACILITY NUMBER:
410503100
ADMINISTRATOR/
DIRECTOR:		OLDENBURG, ZACFACILITY TYPE:
850
ADDRESS:2245 AVY AVE.TELEPHONE:
(650) 854-4545
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 67TOTAL ENROLLED CHILDREN: 67CENSUS: 55DATE:
03/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:04 AM
MET WITH:Zac OldenbergTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 03/28/25 at approximately 8:45am, Licensing Program Analyst (LPA) Katie Krenn arrived at the facility for a case management visit following up on an Unusual Incident (UIR) that the facility self reported on 03/17/25. LPA met with the Assistant Director Zac Oldenberg, Associate Head of School for Academics Sara Poplack, Associate Head of School Olana Khan and explained the purpose of today's visit. Later the Head of the School, Diane Rosenberg joined the meeting. In addition to the administrative staff, LPA observed nine teachers and 55 preschool children (ages 3-5)

LPA did a physical plant inspection, which included four classrooms, an outdoor play area, and a multi-purpose room. LPA did not find any areas of non-compliance.

Based on the facility's investigation they think that the incident occurred on January 23, 2025. The incident involved one child (C1) and one substitute teacher (T1). C1 reported the event to their parents some time after it happened. The day after the C1 told their parents on 02/12/25, the parents reported the incident to the school. The facility investigated the matter conducting interviews with all the parties involved. The facility concluded that both sides of the story could be true. C1 claimed that T1 had intentionally violated their personal rights, T1 has stated that the interaction had been accidental.

LPA inquired why the facility did not contact licensing in a timely matter. The facility said that they had reported to a different agency and was told by that agency, that the agency would contact licensing.
NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2025
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: PHILLIPS BROOKS NURSERY SCHOOL
FACILITY NUMBER: 410503100
VISIT DATE: 03/28/2025
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LPA said that it is not uncommon for people to sometimes mistakenly report to that agency. LPA explained the jurisdiction of each agency, so the staff was clear on the difference. LPA gave an example regarding when an event at school would need to be reported to the other agency. In that case, the school still needs to contact licensing. LPA reminded the school that it is always the school's responsibility to contact licensing.

LPA also reviewed the section 101212 of Title 22, Division 12, Reporting Requirements with the facility to ensure that they understand the requirement of that regulation. The staff expressed appreciation for the clarity that the LPA provided.

LPA did not issue any citations during this visit.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted with Head of the School, Diane Rosenberg.
NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC809 (FAS) - (06/04)
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