<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518992
Report Date: 06/07/2024
Date Signed: 06/07/2024 09:46:45 AM

Document Has Been Signed on 06/07/2024 09:46 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SAN MATEO-FOSTER CITY SCHL DIST - LEAD ELEMENTARYFACILITY NUMBER:
410518992
ADMINISTRATOR/
DIRECTOR:		CRISTINA HALEYFACILITY TYPE:
850
ADDRESS:949 OCEAN VIEWTELEPHONE:
(650) 312-7550
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 57DATE:
06/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Cristina HaleyTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 07, 2024, at approximately 8:30am, Licensing Program Analysts (LPAs) Ly and Basak conducted a Case Management Inspection at the facility due to a self reported incident. During today's visit, LPA met with facility Director Cristina Haley. There were 57 children and 9 staff caring for the children.

During today's visit, LPA interviewed the Director regarding the self reported Unusual Incident Report. Based on interview, the class was lining up to go the the school library, a 4 year old child left the line and went to the bathroom within the classroom. The staff didn't see child left for the bathroom and the whole class left for the library. After using the bathroom, child left the classroom, opened the school gate and attempted to go home to his mother. School staff was out for a walk and found child by the corner of the school. Per Director, family of child was informed and facility held a meeting with family regarding future plans on how issues like this will not happen again. Per Director, school also has a system in place to always keep track of the children

Based on interview and information collected, facility violated the Care and Supervision Regulation. LPA discussed protocols and policies with the supervisor and advised that they need to develop protocols to prevent future incidents. Child was able to leave the group and premises poses an immediate health and safety risk to children in care. Type A deficiency is being cited today in accordance with in accordance with the California Code of Regulations, Title 22, see LIC 809D.

Plans of Corrections (POC) were developed and reviewed with Director. A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to the Director. Director was advised Notice of Site Visit to remain posted for 30 days. Type “A”violation has been issued today. Director is advised to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/07/2024 09:46 AM - It Cannot Be Edited


Created By: Winnie Ly On 06/07/2024 at 09:21 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: SAN MATEO-FOSTER CITY SCHL DIST - LEAD ELEMENTARY
FACILITY NUMBER: 410518992

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
This requirement was not met as evidence based on interviews conducted with Director
1
2
3
4
5
6
7
Staff have been reminded to make sure to always maintain 100% supervision of a child, 100% of the time. Facility has conducted meeting with staff regarding system to always keep track of children.
8
9
10
11
12
13
14
Based on interview with the Director, child was able to leave the classroom, opened the school gate and attempted to go home to his mother. This poses an immediate health and safety risk to children in care
8
9
10
11
12
13
14
This facility will be scheduled for a Non- Compliance conference at the Peninsula Regional Office. Letter of Non Compliance will be mailed to the facility with a date and time of the Non-Complaince Conference.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Garfield Leung
LICENSING EVALUATOR NAME:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2