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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004883
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:53:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2023 and conducted by Evaluator Marie Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20230518110240
FACILITY NAME:EMPIRE PRESCHOOL SMFACILITY NUMBER:
414004883
ADMINISTRATOR:SARAH JENFACILITY TYPE:
850
ADDRESS:3080 LA SELVA STREETTELEPHONE:
(650) 678-3638
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:102CENSUS: 21DATE:
06/15/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Bonnie Li and Sarah JenTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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- Unqualified staff are providing care to day care children without supervision.
- Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced subsequent complaint inspection to close out complaint. LPA met with facility representative and lead teacher Bonnie Li and explained purpose of the inspection. Present in the program when LPA arrived were the Lead Teacher, a teacher's assistant, and six children. A second teacher's assistant and nine more children arrived a short time later.

During the course of the investigation, LPA toured the facility and conducted interviews. During LPA's initial tour today, LPA observed teacher's assistant (T1) with two children in care in classroom 3. Four more children arrived a short time later. LPA also observed four children in classroom 1 unsupervised. Lead teacher was in the infant classroom (under license #414004884) and only moved to a preschool classroom when an infant teacher arrived.

Based on information gathered, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 05-CC-20230518110240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: EMPIRE PRESCHOOL SM
FACILITY NUMBER: 414004883
VISIT DATE: 06/15/2023
NARRATIVE
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Based on information gathered, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies cited today under California Code of Regulations, Title 22, Division 12, follows on LIC 9099D.

LPA Marie Rodriguez informed facility representative Bonnie Li that this report dated June 15, 2023 documents two Type A citations which shall be posted for 30 consecutive days as there is immediate risk to the health and safety of children in care.

Also, LPA Marie Rodriguez informed facility representative to provide a copy of this licensing report dated June 15, 2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


Exit interview was conducted and report was discussed with facility representative Bonnie Li. A copy of the Appeals Rights was provided. 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.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 05-CC-20230518110240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: EMPIRE PRESCHOOL SM
FACILITY NUMBER: 414004883
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2023
Section Cited
CCR
101216.2(e)
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Teacher Aide Qualifications and Duties
(e) An aide shall work only under the direct supervision of a teacher.

This requirement has not been met as evidenced by:
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An office meeting will be scheduled with the Licensee due to continued citations under this regulation.
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LPA observed teacher's assistant T1 in classroom 3 by themselves with up to seven children which poses an immediate health and safety risk to children in care.
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An immediate civil penalty of $500 will be assessed.
Type A
06/16/2023
Section Cited
CCR
101216.3(a)
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Teacher-Child Ratio

There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.

This requirement has not been met as evidence by:
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An office meeting will be scheduled with the Licensee due to continued citations under this regulation.
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LPA observed four children in classroom 1 without any supervision. This poses an immediate health and safety risk to children in care.
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An immediate civil penalty of $500 will be assessed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3