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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004434
Report Date: 07/26/2022
Date Signed: 07/26/2022 03:00:09 PM

Document Has Been Signed on 07/26/2022 03:00 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NOE VALLEY KIDSFACILITY NUMBER:
384004434
ADMINISTRATOR:TOLEDO, JORDANFACILITY TYPE:
830
ADDRESS:3800 22ND STREETTELEPHONE:
(415) 619-2293
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 29DATE:
07/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Mirana PanTIME COMPLETED:
03:00 PM
NARRATIVE
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On July 26, 2022, Licensing Program Analysts (LPAs) Van and Garcia met with the owner, Miranda Pan, for an initial complaint investigation. During the complaint visit, LPAs reviewed the teachers' records. LPAs found four teachers had no fingerprint clearance associated with the Noe Valley Kids. As a result, the following Title 22 deficiency is cited on the next page, and civil penalties of $100 each were issued.

The report was reviewed and signed by the owner, Miranda Pan. Today's report, 7/26/2022, and notice of site visit will be sent to the Licensee email by the close of business on 7/26/22. Confirmation of receipt is required.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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 07/26/2022 03:00 PM - It Cannot Be Edited


Created By: Brendon Van On 07/26/2022 at 01:11 PM
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: NOE VALLEY KIDS
FACILITY NUMBER: 384004434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/08/2022
Section Cited
CCR
101170(e)(2)

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101170 Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or
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Licensee shall submit a written Plan of Correction (POC), ensuring new employees submit a request for the Live Scan application or transfer request. Written POC shall also describe how the Licensee shall prevent future recurrences of this deficiency. (During the inspection, the owner accessed Guardian and associated all four staff to her facility. This deficiency is considered corrected and cleared as of today.)
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This evidence is not met, as evidenced by records review, Licensee failed to ensure all employees had a criminal record clearance associated to the facility prior to employment, posing an immediate health and safety risk to children in care. The review of the staff file confirmed that four staff did not have a criminal record clearance. $100 CIVIL PENALTY ASSESSED for each staff.
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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:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022


LIC809 (FAS) - (06/04)
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