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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001492
Report Date: 09/19/2023
Date Signed: 09/19/2023 01:48:03 PM

Document Has Been Signed on 09/19/2023 01:48 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
SAN BRUNO CC RO, 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: 158TOTAL ENROLLED CHILDREN: 158CENSUS: 90DATE:
09/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa Becker TIME COMPLETED:
02:00 PM
NARRATIVE
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On 9/19/2023 at 8:55AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Lisa Becker. Purpose of the inspection was explained. Case management report is to cite for deficiencies observed during facility's unannounced, 10-day complaint inspection. Present was the Director and 12 staff supervising 90 children. Children present have been signed in. LPA inspected facility for health and safety hazards.

At 12:20PM., Based on observation, LPA confirmed cement piece and tarps are exposed in the outdoor play area (Toddler yard).



Based on today’s inspection, deficiencies were observed in areas evacuated according to the Title 22, Division 12, Chap, 1 of Ca, Code of Regulations and cited on the 809D. An exit interview, appeal rights, and plans for correction were discussed with the Director, Lisa Becker and signature of this form acknowledges the receipt of these documents.

A copy of this report and appeal rights were reviewed and provided to the administrator.
Notice of site visit was given and shall remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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 09/19/2023 01:48 PM - It Cannot Be Edited


Created By: Luis Gomez On 09/19/2023 at 12:51 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: 09/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2023
Section Cited
CCR
101238(a)

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101238(a) Building and Ground: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
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Facility will remove foreign objects from tanbark area, and replenish tanbark to appropriate level by the due date: 10/2/2023.
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At 12:20PM., Based on observation, LPA confirmed cement piece and tarps are exposed in the outdoor play area (Toddler yard). This poses a potential health and safety risk to children in care.
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Facility will submit proof of correction to the department via email.

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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023


LIC809 (FAS) - (06/04)
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