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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004603
Report Date: 10/10/2023
Date Signed: 10/10/2023 12:03:29 PM

Document Has Been Signed on 10/10/2023 12:03 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:LITTLE ROBLES IN THE SUNSETFACILITY NUMBER:
384004603
ADMINISTRATOR:QUINONEZ, KIMBERLYFACILITY TYPE:
850
ADDRESS:1319 20TH AVENUETELEPHONE:
(415) 508-7313
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 34DATE:
10/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kimberly Quinonez and Francesca AmellaTIME COMPLETED:
12:15 PM
NARRATIVE
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On October 10, 2023, at approximately 10:45am, Licensing Program Analyst (LPA) Ly conducted a Case Management Inspection at the facility due to a self reported incident. During today's visit, LPA met with facility Director Kimberly Quinonez and Site Supervisor Francesca Amella. There were 33 children and 13 staff present during today's visit. The children were at the park when LPA arrived.

During today's visit, LPA interviewed the Director and the Site Supervisor regarding the self reported Unusual Incident Report. Based on interviews, a 2 years and 9 month old child was able to open the emergency exit, walk down the hall way and exit the building. Child was found by the Director at the main entrance of the facility.

Based on interviews and information collected, facility violated the Care and Supervision Regulation. LPA discussed protocols and policies with the Director and advised that they need to develop protocols to prevent future incidents. Per Director, facility immediately held a staff meeting to remind staff to make sure to always maintain 100% supervision of the children. A door bell was also installed. Door bell would sound when emergency door is open to alert the adults on site that someone has open the door. A Child was able to open the door and leave the building poses an immediate health and safety risk to children in care. Type A deficiency is being cited today in accordance with the California Code of Regulations, Title 22, see LIC 809D. Immediate Civil Penalty $500 Assessed on this day.

Plans of Corrections (POC) were developed and reviewed with Director. A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of reports. Director is advised to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. Notice of Site Visit shall remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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 10/10/2023 12:03 PM - It Cannot Be Edited


Created By: Winnie Ly On 10/10/2023 at 11:20 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: LITTLE ROBLES IN THE SUNSET
FACILITY NUMBER: 384004603

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/10/2023
Section Cited
CCR
101229(a)(1)

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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 was not met as evidence based on interviews conducted with Director and Site Supervisor.
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Since incident, facility has installed bell which would sound when emergency door is open. Facility also held a staff meeting to remind staff to make sure to always maintain 100% supervision of the children, 100% at all time.
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Child was able to open the emergenchy exit and exit the building. Child was found by the main entrance of the facility.
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This facility will be scheduled for a Non- Compliance conference at the Peninsula Regional Office. Letter of Non Compliance will be mailed to the facility with a date and time of the Non-Complaince Conference.

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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: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023


LIC809 (FAS) - (06/04)
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