414004883-6-15-2023-05-CC-DJOO-CTMVGQ-20230711162555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414004883
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:55:30 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
05/15/2023 and conducted by Evaluator Marie Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20230515100616

FACILITY NAME:	EMPIRE PRESCHOOL SM		FACILITY NUMBER:	414004883
ADMINISTRATOR:	SARAH JEN		FACILITY TYPE:	850
ADDRESS:	3080 LA SELVA STREET		TELEPHONE:	(650) 678-3638
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	102	CENSUS: 21	DATE:	06/15/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Bonnie Li		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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- Staff leave children unattended in the classroom

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 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. Upon tour of the facility today, LPA observed four children in classroom 1 with no supervision. Lead teacher was in the infant classroom (under license #414004884). Per interviews conducted, there appears to be not enough staff coverage before 9:00am.

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

(Continued on LIC 9099-C)

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 4

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
05/15/2023 and conducted by Evaluator Marie Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20230515100616

FACILITY NAME:	EMPIRE PRESCHOOL SM		FACILITY NUMBER:	414004883
ADMINISTRATOR:	SARAH JEN		FACILITY TYPE:	850
ADDRESS:	3080 LA SELVA STREET		TELEPHONE:	(650) 678-3638
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	102	CENSUS:	DATE:	06/15/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Bonnie Li		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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- Staff do not permit parents to enter and inspect the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced subsequent complaint inspection to close out a 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 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. Based on information gathered, there is insufficient evidence to prove that parents are not allowed to enter and inspect the facility. Per interviews conducted, there are no restrictions for parents to ask to come into the facility during the course of the day. Parents and children are met at the front entrance of the facility by a teacher during drop off and pick up for security purposes.

Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are found to be UNSUBSTANTIATED.

Exit interview conducted and report was reviewed with Facility Representative Bonni Li.

Unsubstantiated

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: 4 of 4

Control Number 05-CC-20230515100616

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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(Continued from LIC 9099)

Deficiency 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 one Type A citation 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 report 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: 2 of 4

Control Number 05-CC-20230515100616

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 101216.3(a)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	An office meeting will be scheduled with the Licensee due to continued citations under this regulation.
	8 9 10 11 12 13 14	LPA observed four children in classroom 1 without any supervision. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	An immediate civil penalty of $500 will be assessed.
	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.

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)

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