384002040-1-2-2024-05-CC-GLEG-CZZ3U2-20240130173249

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 384002040
Report Date: 01/02/2024
Date Signed: 01/02/2024 01:28:13 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
11/13/2023 and conducted by Evaluator Cindy Mok

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20231113085010

FACILITY NAME:	ST.THOMAS THE APOSTLE PRE&K LRNG CTR		FACILITY NUMBER:	384002040
ADMINISTRATOR:	MEN, JIA JUN		FACILITY TYPE:	850
ADDRESS:	710 - 40TH AVENUE		TELEPHONE:	(415) 387-5511
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY:	75	CENSUS: 52	DATE:	01/02/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Jia Jun Men (Jessie Men)		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not supervise children at all times

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Mok conducted an unannounced inspection to finalize this complaint. LPA met with the Site Director, Jia Jun Men (Jessie Men), and explained the purpose of the inspection to her. There were 52 children with 10 staff present. Based on the interviews with witnesses conducted by CCL, there was sufficient evidence to prove the children left the classrooms to the bathroom without 100 percent care and supervision from staff in person or visually.

Based on the interviews that CCL conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

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

Control Number 05-CC-20231113085010

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: ST.THOMAS THE APOSTLE PRE&K LRNG CTR	FACILITY NUMBER: 384002040
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/02/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/05/2024 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1) Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.	1 2 3 4 5 6 7	The Site Director will provide a Care and Supervision Training to all staff. Copies of theTraining Material and attendance sheet with staff signatures for the training must send to CCL by 1/5/2024
	8 9 10 11 12 13 14	This requirement was not met as evidence-based upon the interviews, the children left the classrooms to the bathroom without 100 percent care and supervision from staff in person or visually. This poses a potential health risk to children in care.	8 9 10 11 12 13 14
	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.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 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
11/13/2023 and conducted by Evaluator Cindy Mok

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20231113085010

FACILITY NAME:	ST.THOMAS THE APOSTLE PRE&K LRNG CTR		FACILITY NUMBER:	384002040
ADMINISTRATOR:	MEN, JIA JUN		FACILITY TYPE:	850
ADDRESS:	710 - 40TH AVENUE		TELEPHONE:	(415) 387-5511
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY:	75	CENSUS: 52	DATE:	01/02/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Jia Jun Men (Jessie Men)		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility blocked a passageway with an object.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Mok conducted an unannounced inspection to finalize this complaint. LPA met with the Site Director, Jia Jun Men (Jessie Men), and explained the purpose of the inspection to her. There were 52 children and 10 staff present. Based on the Licensing Program Analyst's observation, the facility blocked one of the entrances with a piece of learning equipment in a Pre-K classroom.

Based on the LPA's observation, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 05-CC-20231113085010

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: ST.THOMAS THE APOSTLE PRE&K LRNG CTR	FACILITY NUMBER: 384002040
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/02/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/03/2024 Section Cited CCR 101238(c)	1 2 3 4 5 6 7	101238 (c) Buildings and Grounds All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept	1 2 3 4 5 6 7	The Site Director removed a piece of learning equipment from the entrance of a Pre-K classroom permanently. The Site Director assigns a teacher to stay by that entrance to prevent children from leaving that classroom whenever the children are there. The deficiency was cleared during the inspection.
	8 9 10 11 12 13 14	This requirement was not met as evidence based upon the LPA's observation to prove the facility blocked one of the entrances with a piece of learning equipment in a Pre-K classroom. This poses a potential health risk to children in care.	8 9 10 11 12 13 14
	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.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Mok	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4