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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509589
Report Date: 10/06/2026
Date Signed: 10/06/2026 11:32:47 AM

Document Has Been Signed on 10/06/2026 11:32 AM - 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:HOPE LUTHERAN DAYSCHOOLFACILITY NUMBER:
410509589
ADMINISTRATOR/
DIRECTOR:		HUANG, CYNTHIAFACILITY TYPE:
850
ADDRESS:55 SAN FERNANDO WAYTELEPHONE:
(650) 991-4673
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 170TOTAL ENROLLED CHILDREN: 170CENSUS: 130DATE:
10/06/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Shirley Ngai & Cynthia HuangTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On October 6, 2026, Licensing Program Analyst (LPA) Van conducted an announced case management inspection regarding a reported unusual incident in which three children separated from their classroom group and entered the facility parking lot without staff supervision. At the time of the inspection, 20 staff supervised 130 children. The facility complied with its licensed capacity, limitations, and required staff-to-child ratio. The Site Director, Cynthia Huang, arrived during the inspection.

The incident occurred on September 21, 2026, while the Colt classroom transitioned to an outdoor bathroom. After using the bathroom, C1, C2, and C3 did not line up with their group and walked away without staff supervision. At approximately 10:13 a.m., S1 located the children on the sidewalk near the parking lot entrance, where a passerby had stopped them from continuing farther. The facility’s surveillance footage showed that the children were unsupervised for approximately seven minutes.

Based on the report submitted, a newly installed accessible parking area and railing had altered the usual walkway. The children reportedly entered the parking lot while attempting to walk around the railing. A parent and another individual observed the children, and the individual exited their vehicle and notified facility staff.

Continued on page 2.

Garfield Leung
Brendon Van
DATE: 10/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2026
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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Document Has Been Signed on 10/06/2026 11:32 AM - It Cannot Be Edited


Created By: Brendon Van On 10/06/2026 at 11:10 AM
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: HOPE LUTHERAN DAYSCHOOL
FACILITY NUMBER: 410509589

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2026
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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By October 7, 2026, the facility shall train all staff on active supervision, visual observation, head-count procedures, staff positioning, and classroom transitions. The facility shall implement written procedures requiring staff to conduct and document head counts before and after each transition, assign staff to the front and rear of each group, allow only one classroom at a time to use the bathroom transition area, and ensure all gates remain secured.
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Based on staff interviews, the incident report, and surveillance footage, the facility did not comply with the section cited above because it failed to ensure that C1, C2, and C3 remained under staff supervision. During a bathroom transition, the children separated from their classroom group, entered the facility parking lot, and remained without visual supervision for approximately seven minutes. The children were found on the sidewalk near the parking lot entrance after a passerby stopped them from going farther. This posed an immediate risk to the children’s health and safety.

An immediate $500 civil penalty is assessed today.
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The facility shall submit the written procedures, training materials, and a staff attendance sheet containing each staff member’s printed name, signature, and training date to the Department by the POC due date.

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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.
Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:
Brendon Van
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2026


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: HOPE LUTHERAN DAYSCHOOL
FACILITY NUMBER: 410509589
VISIT DATE: 10/06/2026
NARRATIVE
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page 2.
During today’s inspection, LPA interviewed staff members with firsthand knowledge of the incident and, with the facility representative, walked the route the children took. LPA also reviewed the facility’s transition and supervision procedures, staff positioning, the newly installed railing, and measures implemented to prevent recurrence.

See LIC 809D for the Type A deficiency cited and civil penalty assessed today.

LPA Van informed the Director, Cynthia Huang that this report dated October 6, 2026, document(s) a Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Van informed the Director to provide a copy of this licensing report dated October 6, 2026, 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 Acknowledgment of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with Site Director Cynthia Huang.

A copy of this report and appeal rights were reviewed and provided to the Site Director.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Brendon Van
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2026
LIC809 (FAS) - (06/04)
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