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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001493
Report Date: 01/17/2020
Date Signed: 01/17/2020 02:57:24 PM

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:
414001493
ADMINISTRATOR:ROBINSON, ONEIKIFACILITY TYPE:
830
ADDRESS:1050 TWIN DOLPHIN DRIVETELEPHONE:
(650) 594-1100
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY:112CENSUS: 48DATE:
01/17/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:CASSANDRA HUNTOONTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst Jyoti Saini conducted Case Management visit this day and met with Director- Cassandra Huntoon. LPA explained the purpose of the visit. Today, LPA observed 48 infants with 12 staff. LPA and the director of the facility Cassandra Huntoon inspected the child care area for health and safety hazards. During an inspection, it was confirmed that one teacher in Infant room#1 AKS ( Angelfish) did not receive fingerprint clearance and one teacher in Toddler room AKS (Norwhal) does not have finger print clearance associated to the facility. LPA observed that both the teachers are in the contact with children.

California Code of Regulations, Title 22 deficiencies are being cited.


The following items need to be completed and returned to Licensing by 01/31/20:
-PERSONNEL REPORT (LIC 500)

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

This TYPE A citation page shall be posted for 30 days along with the “Notice of Site Visit.” This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB 633 requirements.

"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS. LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH APPLICANT/PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 414001493
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/21/2020
Section Cited

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101170 (a)Criminal Record Clearance- The Department shall conduct a criminal record review of all persons specified in Health and Safety Code Section 1596.871(b). The Department has the authority to approve or deny employment, or presence in the facility, based on the results of this review.
This requirement was not met as evidenced by:
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Based on observations and record review the facility was found to have an uncleared indvidual on staff since 14th Jan 2020. This poses an immeadiate health and safety risk to children in care.
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Type A
01/21/2020
Section Cited

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101170(e)(2) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trust line.



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Based on the observation and record review, staff has criminal record clearance, but is not associated to the facility fingerprint list.

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LPA received LIC 9182 and a copy of ID card during a visit.
Civil penalties were assessed to day in the amount of $100.00

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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2020
LIC809 (FAS) - (06/04)
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