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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002897
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:28:03 PM

Document Has Been Signed on 03/11/2025 03:28 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:ALL SOULS PRESCHOOLFACILITY NUMBER:
414002897
ADMINISTRATOR/
DIRECTOR:		ERIC LIUFACILITY TYPE:
850
ADDRESS:479 MILLER AVENUETELEPHONE:
(650) 871-1751
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
03/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Claudia Escobar(Office Manager) TIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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S1= Staff ; C1= Child 1

On March 11, 2025 at approximately 9:00AM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced, case management visit in regards to an incident that was self reported to department on February 28, 2025. LPA met Office Manager, Claudia Escobar and explained the purpose of the visit. Present during LPA's visit included 2 staff members supervising 7 (Preschool) children. All staff current are fingerprinted and associated.

On February 7, 2025 at approximately during scheduled nap time, S1 was supervising children in care.

On the date of the incident, it was observed Via school cameras. S1 was observed physically moving C1 from one nap corner to another, in two occasions during a 10 minute period. On February 28, 2025, School Principal reported the incident. School Principal submitted video to the Archdiocese of San Francisco Department of Catholic Schools to conduct an internal investigation. As of March 3, 2025 S1 was placed on administrative leave.

During today's visit, LPA conducted staff interviews, watched video footage, and inspected the room.

LPA determined personal rights were violated on February 7, 2025 during the scheduled nap time.

Facility is being cited under Title 22, Division 12, Chapter 1. See 809D for details. A hard copy of today's report was provided to Office Manager, Claudia Escobar and as well as appeal rights were provided.

A notice of site visit was given and must remain posted.

Exit interview conducted and report was reviewed with Office Manager, Claudia Escobar.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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 03/11/2025 03:28 PM - It Cannot Be Edited


Created By: Diana Alvarado On 03/11/2025 at 02:55 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: ALL SOULS PRESCHOOL
FACILITY NUMBER: 414002897

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2025
Section Cited
CCR
101223(a)(3)

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(a) (3) The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
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Staff will conduct trainings in regard to personal rights and licensing. Facility will submit via email to LPA Alvarado documentation and proof of completed trainings by 3/28/25. LPA Alvarado will conduct a follow up visit.
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Based on observation and interview, the facility did not comply with the section cited above as LPA at 12:20PM observed S1 remove C1 during scheduled nap time, the video footage was for an incident that occured Febuary 7, 2025 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:Diana Alvarado
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2025


LIC809 (FAS) - (06/04)
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