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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001649
Report Date: 04/11/2023
Date Signed: 04/11/2023 03:42:29 PM

Document Has Been Signed on 04/11/2023 03:42 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:MARIN DAY SCHOOL-OUR PLACE, SMC EMP (PRESCHOOL)FACILITY NUMBER:
414001649
ADMINISTRATOR:SILVA JENNIFERFACILITY TYPE:
850
ADDRESS:403 WINSLOW STREETTELEPHONE:
(650) 363-4939
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 64TOTAL ENROLLED CHILDREN: 34CENSUS: 30DATE:
04/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Director, Jennifer SilvaTIME COMPLETED:
04:15 PM
NARRATIVE
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On April 11th, 2023 at approximately 1:50pm, Licensing Program Analyst, (LPA) Tapia-Mandujano arrived at the facility for a Case Management-Incident inspection. LPA met with Director, Jennifer Silva. The purpose of today's inspection was explained. Inspection is for a response to an Unusual Incident Report received by the department on March 24, 2023. Present in the facility are five staff supervising 30 preschool age children. Facility is operating within capacity limits. All adults in the facility are fingerprint cleared and associated.

The facility self reported an incident. The incident involved lack of supervision that resulted when a teacher responsible for supervising a group of 7 preschool children, transitioned back to the classroom from the play yard, leaving a child outside for about 30 seconds without direct visual supervision. Play yard is directly outside of the classroom, and child was able to call out to the teacher and was let back in. Per Director, the teacher notified the director of the incident after it occurred.

During today's inspection, LPA inspected the room, where the incident took place. LPA spoke with the Director, and was unable to speak to the teacher involved due to not being present during today's inspection. Per interview with the Director, immediate actions were take. Per interview with Director, parents were notified, and the teacher involved has ongoing training to ensure policies are understood and are followed at all times. Facility does name to face recognition and do it twice through "My Bright Day" app.

Due to a potential health and safety risks for lack of supervision, a Type B deficiency has been issued. Please see LIC 809D for more details.

This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. An exit interview was conducted with Director, Jennifer Silva
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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 04/11/2023 03:42 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 04/11/2023 at 03:17 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: MARIN DAY SCHOOL-OUR PLACE, SMC EMP (PRESCHOOL)
FACILITY NUMBER: 414001649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2023
Section Cited
CCR
101229(a)(1)

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101229 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... Supervision shall include visual observation. This requirement was not met as evidenced by:
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Director has trained involved staff on supervising procedures and is practicing the procedures with the staff to ensure that all children are accounted for at every transition.
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Based on interview, the licensee did not comply with the section cited above as facility self reported that there was a child left alone outside during transition back to the classroom from the play yard, which poses a potential health, safety or personal rights risk to persons in care.
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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:Ali Zebila
LICENSING EVALUATOR NAME:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023


LIC809 (FAS) - (06/04)
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