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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004586
Report Date: 11/07/2023
Date Signed: 11/07/2023 04:02:44 PM

Document Has Been Signed on 11/07/2023 04:02 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:PINE CONE CHILDREN'S CENTERFACILITY NUMBER:
414004586
ADMINISTRATOR:ALVARADO, MICAELAFACILITY TYPE:
830
ADDRESS:900 BARRON AVENUETELEPHONE:
(650) 497-0013
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 46TOTAL ENROLLED CHILDREN: 35CENSUS: 23DATE:
11/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Director, Micaela "Mickey" Alvarado and Assistant Director, Janelle ArdeTIME COMPLETED:
04:15 PM
NARRATIVE
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On November 7th, 2023 at approximately 2:40pm, Licensing Program Analyst, (LPA) Tapia-Mandujano arrived at the facility for a Case Management-Incident inspection. LPA met with Director, Micaela Alvarado and Assistant Director, Janelle Arde. The purpose of today's inspection was explained. Inspection is for a response to an Unusual Incident Report that occurred on October 27th, 2023 and received by the department on November 3rd, 2023.

Facility is dually licensed with a Preschool License on site. Facility operates in the infant/toddler classrooms that consists of 4 total classrooms. Facility is operating within capacity limits. All adults in the facility are fingerprint cleared and associated.

The facility self reported an incident that occurred on October 27th, 2023. The incident involved lack of supervision that resulted in a child being left unsupervised in the outdoor play yard. Per conversation with Director and assistant Director, there was a lack of communication within the two closing teachers that resulted in a child being left alone for approximately 1-2 minutes. Per Director and assistant, there was a parent on the yard with her own child, and teachers in the 2's yard that could see the child.

During today's inspection, LPA inspected the area where the incident took place. Per conversation with Director and assistant Director, immediate action was taken and the two staff involved were put on administrative leave, as well as all staff were retrained on the transition tracking policies, as well as handing out the policies to staff, and observing the staff to ensure the transition tracking policies are being done correctly.

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. Notice of site visit shall be posted for 30 days from today's visit. An exit interview was conducted with Director, Micaela Alvarado. Due to technical difficulties, report was emailed to Director and LPA confirmed that the email was received.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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 11/07/2023 04:02 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 11/07/2023 at 03:43 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: PINE CONE CHILDREN'S CENTER
FACILITY NUMBER: 414004586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2023
Section Cited
CCR
101229(a)(1)

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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."
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Director has came up with an action plan to retrain all staff on policies and procedures for Supervision and transitions.

Facility will have all staff review and acknowledge the written polices and procedure for supervision and transitioning.
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Based on interviews conducted, the facility did not comply with the section cited above as facility self reported that there was a child left alone outside on the outdoor play yard, which poses a potential health, safety or personal rights risk to persons in care.
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 Facility will submit written action plan of steps that were taken and obtain signatures of all staff that they understand the policies on supervision and transitioning and submit via email to LPA Tapia-Mandujano by 11/21/23.

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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:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023


LIC809 (FAS) - (06/04)
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