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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504442
Report Date: 02/28/2024
Date Signed: 02/28/2024 12:24:52 PM

Document Has Been Signed on 02/28/2024 12:24 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SFUSD-NORIEGA EARLY EDUCATION SCHOOL (PS)FACILITY NUMBER:
380504442
ADMINISTRATOR:NG, IVYFACILITY TYPE:
850
ADDRESS:1775 - 44TH AVENUETELEPHONE:
(415) 759-2853
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 136TOTAL ENROLLED CHILDREN: 136CENSUS: 104DATE:
02/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ivy NgTIME COMPLETED:
12:45 PM
NARRATIVE
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On February 28, 2024 at approximately 10:30am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit for a self reported Unusual Incident that was reported to the department on 02/20/2024 and met with Principal, Ivy Ng during the visit. Purpose of the inspection was explained. There were 18 staff caring for 104 children during the visit.

During today's visit, LPA interviewed the Principal to obtain detail information into the Unusual Incident and follow up protocols the school implemented after the incident. Based on information collected, a child left the classroom and out into the play yard. Child was found with the mother in the yard. Facility staff lost site of child for an unknown period of time. Since the incident, Principal had conducted staff meeting regarding different ways to have 100% supervision of children at all time. Principal also had a meeting with child's parent. Classroom teachers had circle time with children reminding children not to leave the classroom without an adult that child knows.

This self reported incident is deemed as the lack of supervision. Type B violation has been issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

A copy of this report and appeal rights were discussed and left with Principal whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days.
Garfield Leung
Winnie Ly
DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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 02/28/2024 12:24 PM - It Cannot Be Edited


Created By: Winnie Ly On 02/28/2024 at 11:46 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: SFUSD-NORIEGA EARLY EDUCATION SCHOOL (PS)
FACILITY NUMBER: 380504442

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2024
Section Cited

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101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
This requirement is not met as evidenced by:
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Based on self reported unusual incident and detail information collected during visit, staff did not see child left the classroom. Child was later found in the playground with child's mother.
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This deficiency is considered corrected and cleared as of today.

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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:Garfield Leung
LICENSING EVALUATOR NAME:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


LIC809 (FAS) - (06/04)
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