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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004751
Report Date: 04/18/2024
Date Signed: 05/02/2024 09:30:13 AM

Document Has Been Signed on 05/02/2024 09:30 AM - 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:KANEKO, SATOEFACILITY NUMBER:
414004751
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
04/18/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:28 PM
MET WITH:Satoe KanekoTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On April 18, 2024 @ approx. 1:30 pm, Licensing Program Analyst (LPA) Maria Olguin-Leon, conducted an unannounced, plan of correction (POC) visit. LPA met with Licensee, Satoe Kaneko, and explained the purpose of the visit. Present during visit was Licensee, and 3 children (1 infants and 2 preschool age). Licensee is within ratio of staff/children capacity.

On April 4, 2024, LPA Maria Olguin-Leon met with licensee for an annual inspection. During visit, LPA cited Licensee two Type A and one Type B deficiencies. Type A deficiencies were cited for over capacity;1 infant, 6 preschoolers and 1 school-age child and for an adult helper with no criminal background clearance. A Type B was cited for children’s roster. POC’s were developed with licensee.

As of this date, LPA Olguin-Leon confirmed the licensee to have one infant and two preschoolers present and 6 children enrolled. Per licensee, helper is in process of fingerprint clearance and has not been present with children. Licensee does not have a children’s roster for LPA to review.

During today's visit, LPA did not observe signed and completed Acknowledgement of Receipt of Licensing Reports (LIC9224) for the 6 children enrolled. Licensee stated licensee’s printer is not working and was unable to print LIC9224 and children’s roster. LPA provided Licensee with a copy of LIC 9224 and children’s roster. LPA is citing a Type B deficiency under Health and Safety code for not providing parents with LIC9224. LPA observed facility site visit and reports posted.

Type A deficiencies cited on April 4, 2024, have been cleared as of this date. LPA provided licensee copy of POC letters. Licensee will complete Children’s roster and email to LPA by 04/19/2024 to clear type B deficiency cited on April 4, 2024.

See page 809D for deficiencies cited today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with licensee, Satoe Kaneko.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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 05/02/2024 09:30 AM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 04/18/2024 at 02:09 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: KANEKO, SATOE
FACILITY NUMBER: 414004751

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2024
Section Cited
CCR
1596.8595(c)(1)

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A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care.
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Licensee will ensure to provide parents with a copy of LIC 809 and LIC 809D to review and have them sign LIC 9224. Facility representative will provide LPA with email photo of signed LIC9224 for the 6 currently enrolled children. Licensee will also ensure newly enrolled parents are provided report and complete the LIC 9224 for the next 12 months.
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Based on interview and file reviews conducted today, facility failed to meet this requirement by not having enrolled children representatives complete and sign LIC9224 Acknowledgement of Receipt of Licensing Reports as required for a type A violation, which is an immediate risk to the health and safety of children in care.

This poses a potential health and safety risk to the 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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024


LIC809 (FAS) - (06/04)
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