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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001492
Report Date: 03/28/2024
Date Signed: 03/28/2024 12:14:16 PM

Document Has Been Signed on 03/28/2024 12:14 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: 116CENSUS: 107DATE:
03/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Director, Lisa BeckerTIME COMPLETED:
12:30 PM
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 March 28th, 2024 at approximately 10:45am, Licensing Program Analyst (LPA) Tapia-Mandujano arrived at the facility to conduct a Case Management-Incident inspection. LPA met with Director, Lisa Becker. The purpose of today's inspection was explained. Inspection is for a response to an Unusual Incident Report that was called received by the department on March 14th, 2024.

Present in the facility are 107 preschool children being supervised by 19 staff. All staff present at this time are fingerprint cleared and associated.

The facility self reported an incident that occurred on March 14th, 2024. The incident involved lack of supervision that resulted in a child being left unsupervised while transitioning from outdoor play yard into the classroom. Per interviews and report, the child was left alone in the hallway for a couple of seconds. Another staff saw a child and opened the door for child to join the group.

During today's inspection, LPA inspected the area where the incident took place. LPA spoke with Director and involved staff about the incident. Parent of unsupervised child was notified. Per Director, immediate action was taken and retraining is happening. LPA also obtained a copy of the name to face log.

Due to a potential health and safety risks for lack of supervision, a Type B deficiency has been issued. Please see LIC 809D for more details.

This report must be available in the facility for public review. Appeal Rights were provided. Notice of site visit shall be posted for 30 days from today's visit. An exit interview was conducted with Director, Lisa Becker.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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 03/28/2024 12:14 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 03/28/2024 at 11:56 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: SHORES CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 414001492

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
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... Supervision shall include visual observation."

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director will submit the action plan to retrain all staff on policies and procedures for Supervision and transitions.

Director will continue to check in on staff during trasitions to ensure the policies are being followed.
8
9
10
11
12
13
14
Based on interview and record review, the facility did not comply with the section cited above as facility self reported that there was a child left alone outside during transition back to the classroom from the outdoor play yard, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Facility will have all staff review and acknowledge the written polices and procedure for supervision and transitions, and will send a copy of each staff acknowliding the policies via email to LPA Tapia-Mandujano by 04/26/24.

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:Marie Rodriguez
LICENSING EVALUATOR NAME:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024


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