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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509079
Report Date: 03/21/2022
Date Signed: 03/21/2022 02:15:11 PM

Document Has Been Signed on 03/21/2022 02:15 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SAN MATEO-FOSTER CITY SCHL DIST - TURNBULL CDCFACILITY NUMBER:
410509079
ADMINISTRATOR:SUMMERS, ELENAFACILITY TYPE:
850
ADDRESS:715 INDIAN AVENUETELEPHONE:
(650) 312-7766
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 264TOTAL ENROLLED CHILDREN: 181CENSUS: 127DATE:
03/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Principal Karrie HaseltonTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced Case Management inspection to follow up on an incident that was reported to CCLD on February 2, 2022. LPA met with Principal Karrie Haselton and explained purpose of visit. Present at the center were the Principal, 11 teachers, 11 assistants, and 127 preschool aged children.

The incident reported to CCLD occurred approximately a week prior where Child C1 and C2 stated to their parents that Staff S1 had put their legs over the children during nap time. Principal was notified of the incident on January 31, 2022 by parents. On February 1, 2022, Principal and Child Development Coordinator Carmen Lo began internal investigation of incident after speaking with parents. During the course of the internal investigation, Principal and Child Development Coordinator conducted interviews with staff and made unannounced observations of classroom during nap time.

Based on investigation completed by center, there was sufficient evidence found that Staff S1 had either leant over a child's legs or put their bent legs over a child's legs without touching them to help assist a child in taking a nap. Staff S1 did not put any pressure on the child's legs or try to restrain them while doing so. Although there was no harmful intent, the action was still considered a form of restraint.

A deficiency has been cited today under California Code of Regulations, Title 22, Division 12, and is listed on LIC809-D.

An exit interview was conducted with Principal Karrie Haselton A copy of this report and appeal rights were provided. Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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 03/21/2022 02:15 PM - It Cannot Be Edited


Created By: Marie Rodriguez On 03/21/2022 at 01:33 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: SAN MATEO-FOSTER CITY SCHL DIST - TURNBULL CDC
FACILITY NUMBER: 410509079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2022
Section Cited
CCR
101223(a)(7)

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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (7) Not to be placed in any restraining device.

This requirement has not been met as evidenced by:
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Center has taken appropriate disciplinary action with Staff S1 and has spoken to staff about a child's personal rights and about restraining a child in care. Center is working with San Mateo County on having an outside vendor provide staff training on personal rights.
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Based on interviews and observations made by Principal and Child Development Coordinator, Staff S1 was observed to lean over a child's legs or put their bent legs over a child's legs without touching them to help assist a child in taking a nap. Although there was no harmful intent, the action of it poses a potential health and safety risk to children in care.
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Deficiency was cleared during inspection.

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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022


LIC809 (FAS) - (06/04)
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