<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000216
Report Date: 12/12/2023
Date Signed: 12/12/2023 01:12:56 PM

Document Has Been Signed on 12/12/2023 01:12 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SKYLINE COLLEGE CDCFACILITY NUMBER:
414000216
ADMINISTRATOR:HERNDON, CHRISTINEFACILITY TYPE:
850
ADDRESS:3300 COLLEGE DRIVETELEPHONE:
(650) 738-7071
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 100TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
12/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Christine HerndonTIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
C1= Child 1; T1= Teacher 1; T2= Teacher 2; TA1= Teacher's Aide; TA2= Teacher's Aide 2.

On December 12, 2023 at approximately 12:40pm, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced case management inspection to Skyline College CDC. LPA met with director, Christine Herndon, and explained the purpose of the inspection. Present during today's visit included 13 preschool children and 6 staff members (including director).

The case management visit is in regards to an unusual incident that occurred December 5, 2023. Director self-reported incident to department.

On December 5, 2023 at approximately 12:45pm, T1, T2 and TA1 were present with 13 children. At time of incident, children were transitioning from outdoor playground area to indoor classroom. TA2 was also present in classroom for additional support. Door to the playground was closed during transitional period.

Once door to playground was closed, C1 knocked on the outside of the door, from the playground. T1 opened the door and C1 rejoined classroom without any injuries.

C1 was left alone on the playground, without staff supervision. Per director, time from children entering classroom from playground, to playground door closing, to C1 knocking on door and rejoining classroom was approximately 5 minutes. C1's authorized representative was informed of incident on the same date. C1 has returned to facility as of 12/06/2023 as per their normal.

Director held a mandatory staff meeting December 8, 2023 enforcing the importance of supervision and additional transitional protocols. Per director, staff are now required to document the time and location whenever a child passes through a classroom door's threshold. Proof of meeting was provided to LPA during case management visit.

Based on record review, interview and director self-reporting, a child was left unattended and without staff supervision during operating hours. Facility is cited a Type B citation for lack of supervision. Please refer to 809D for more information.

A notice of site visit was provided and must remain posted for 30 days. Appeal rights were provided to director.

Exit interview conducted and report was reviewed with director, Christine Herndon.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/12/2023 01:12 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 12/12/2023 at 12:59 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: SKYLINE COLLEGE CDC
FACILITY NUMBER: 414000216

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2023
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision (a)(1) No child(ren) shall be left without the supervision of a teacher at any time.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director conducted a staff meeting on 12/08/2023, reinforcing importance of supervision. Director also implemented additional, classroom transitional protocols that includes documenting the time and location of a child when transitioning.
8
9
10
11
12
13
14
Based on record review and interview which were conducted, C1 was left unattended on the playground and unsupervised by staff.
8
9
10
11
12
13
14
Proof of staff meeting and staff present during meeting was provided to LPA. Deficiency cleared during visit.

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:Marie Rodriguez
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2