414001492-5-30-2023-05-CC-MROZ-CUWVK7-20230821162950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414001492
Report Date: 05/30/2023
Date Signed: 05/30/2023 03:34:20 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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
05/23/2023 and conducted by Evaluator Luis Gomez

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20230523143544

FACILITY NAME:	SHORES CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414001492
ADMINISTRATOR:	BECKER, LISA		FACILITY TYPE:	850
ADDRESS:	1050 TWIN DOLPHIN DRIVE		TELEPHONE:	(650) 594-1100
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94065
CAPACITY:	158	CENSUS: 105	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Lisa Becker, Christina Halverson		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Day care staff are operating out of ratio.

INVESTIGATION FINDINGS:

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On 5/30/2023 at 8:45AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Lisa Becker and Regional Manager, Christina Halverson. Purpose of the inspection was explained and was for an Unannounced, Complaint Investigation. Present was the Director, Regional Manager, and 15 staff caring for 105 children. All children have been signed in. LPA inspected facility for health and safety hazards.

During inspection, LPA performed site observations, interviews and reviewed facility records. LPA collected parent handbook and staff rosters. At 2:20PM., Based on record review, LPA confirmed staff's proof of qualifications were missing from facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

During the course of this investigation, observations were conducted on 5/30/2023. A review of the facility records was complete, which included the staff files and parent handbook. LPA conducted interviews staff, director and involved parties.
(REFER TO LIC9099C, FOR CONT.)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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

Control Number 05-CC-20230523143544

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SHORES CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414001492
	VISIT DATE: 05/30/2023

NARRATIVE

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(Page 2)
Regarding the allegation of facility is operating out of ratio; Based on evidence collected, LPA determined allegation made is valid.

Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) are being cited on attached 9099D. Appeal Rights were provided to licensee.

Notice of site visit was provided and must remain posted for 30 days.

This report will be kept in the facility file and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 05-CC-20230523143544

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SHORES CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414001492
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/09/2023 Section Cited CCR 101216.3	1 2 3 4 5 6 7	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. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director will submit written plan to the department ensuring proper teacher-child ratios are maintained at all times by the due date: 6/9/2023.
	8 9 10 11 12 13 14	Based on evidence collected, LPA determined allegation is valid. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Proof of correction will be submitted via email.
	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.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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