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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001492
Report Date: 09/30/2022
Date Signed: 09/30/2022 03:10:50 PM

Document Has Been Signed on 09/30/2022 03:10 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:SHORES CHILD DEVELOPMENT CENTERFACILITY NUMBER:
414001492
ADMINISTRATOR:BECKER, LISAFACILITY TYPE:
850
ADDRESS:1050 TWIN DOLPHIN DRIVETELEPHONE:
(650) 594-1100
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY: 184TOTAL ENROLLED CHILDREN: 184CENSUS: DATE:
09/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:Lisa BeckerTIME COMPLETED:
03:30 PM
NARRATIVE
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On September 30, 2022 at 1:12 PM, Licensing Program Analyst (LPA) Cowan conducted a Case Management inspection today in response to an Unusual Incident Report received on August 30, 2022 in the Regional Office. The facility self reported the incident. The incident involved a lack of supervision that resulted when a teacher, responsible for supervising a group of 12 preschool children, transitioned back to the classroom from the play yard, leaving a child in the hallway without direct visual observation.
During today's inspection, LPA inspected the room, where the incident took place. LPA Spoke to the Director Lisa Becker, Teacher Grace Guerrero (Dolphins), Teacher Jenn Pineta (Sea Turtles Class) and Deanna Castillo (Assistant Director). Based on the statements obtained from witnesses, it was determined that a lack of care and supervision resulted on August 30, 2022, when Teacher Grace left a preschool child in the hallway for approximately one minute after transitioning children from the play yard back to the classroom. Teacher Grace did not maintain direct visual observation of the child during this period of time. This is an immediate risk to children in care. A type A violation is issued this day. See LIC 809D.

Management and executive staff responded immediately to the occurrence of this incident and spoke to Teacher Grace and coached her discussing policies and procedures for providing care and supervision to children at all times. Director and staff have since developed a system using hallway passes to always account for every child entering and returning to the classroom. Teacher Grace was instrumental in developing this process, and states that this new system has been amazing in making sure that all children remain safe.

An exit interview was conducted with site director Lisa Becker, and Plans of corrections were reviewed and developed with the Director. Appeal Rights were provided and discussed with the Director. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.
This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.
Licensee was advised any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. Website: www.cdss.ca.gov
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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 09/30/2022 03:10 PM - It Cannot Be Edited


Created By: April Cowan On 09/30/2022 at 02:46 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: SHORES CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 414001492

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2022
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)(1)
(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. This requirement was not met as evidenced by:
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Director has trained staff on supervising procedures and implemented a system using hall passes to make sure that children are accounted for at every juncture.
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Based on interviews, Staff did not maintain direct supervision of child in care. This is an immediate risk to children in care.
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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:Garfield Leung
LICENSING EVALUATOR NAME:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022


LIC809 (FAS) - (06/04)
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