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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004946
Report Date: 09/20/2024
Date Signed: 09/20/2024 10:16:28 AM

Document Has Been Signed on 09/20/2024 10:16 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:KIDS KONNECT INFANT CARE & PRESCHOOLFACILITY NUMBER:
414004946
ADMINISTRATOR/
DIRECTOR:		GROMOWSKI, COURTNEYFACILITY TYPE:
830
ADDRESS:137 NORTH SAN MATEO DRIVETELEPHONE:
(510) 305-7857
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 14DATE:
09/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:31 AM
MET WITH:Courtney GromowskiTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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On September 20, 2024, Licensing Program Analyst (LPA) Zeynep Basak conducted a case management inspection and met with the director Courtney Gromowski. The purpose of the visit was explained to the director. Present were the director, 4 teachers, and 14 children in care.

The case management was related to the unusual incident reports submitted by the director on 9/10/24.
The incident was where the staff witnessed a teacher holding down the child during naptime to get the child to sleep.
The director stated the teacher was terminated after the investigation. Per the director, all other staff members were re-informed about Personal Rights on 9/10/2024.

During the inspection, LPA was to get more information on how the incident happened and what was done to prevent it from happening again. The facility will continue to take this matter seriously.

Based on information obtained today Type B violation is being cited, in accordance the California Code of Regulations, Title 22, Division 12 & Chapter 1 (a) (3) and (d) (C) on the attached LIC 809D

An exit interview was conducted with the director Courtney Gromowski. The report and Notice of Site Visit were provided to be posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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 09/20/2024 10:16 AM - It Cannot Be Edited


Created By: Zeynep Basak On 09/20/2024 at 09:48 AM
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: KIDS KONNECT INFANT CARE & PRESCHOOL
FACILITY NUMBER: 414004946

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2024
Section Cited
CCR
101223(a)(3)

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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by:
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The staff was terminated.
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Based on interview during today's visit, the involved staff had violated the children's personal rights which poses a potentital health and safety risk to 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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2024


LIC809 (FAS) - (06/04)
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