FRIENDS OF POTRERO HILL NURSERY SCHOOL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA), Jyoti Saini conducted a case management visit today along with a complaint investigation. In the course of conducting the investigation, LPA inspected the facility and observed violation of Title 22 and Health and Safety Code. At 9:47am, LPA observed an uncleared individual supervising the children. This poses an immediate health and safety risk to children in care. ***California Code of Regulations, (Title 22, Div. 12, Ch 3), are being cited on the attached LIC 809D. "NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS. LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT. An exit interview was conducted. Appeal rights were given and explained to the Director Monica Leicht. Copy of this report was reviewed and will be sent to the director at email address monicaleicht@gmail.com by the close of business on 11/19/2021. Confirmation of receipt is required. SUPERVISORS NAME: Alma Malig LICENSING EVALUATOR NAME: Jyoti Saini LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021 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 FACILITY NAME: FRIENDS OF POTRERO HILL NURSERY SCHOOL FACILITY NUMBER: 384002303 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/19/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 11/22/2021 Section Cited CCR 101170(a) 1 2 3 4 5 6 7Criminal Record Clearance(a) The Department shall conduct a criminal record review of all persons specified in Health and Safety Code Section 1596.871(b). The Department has the authority to approve or deny employment, or presence in the facility, based on the results of this review. This requirement was not met as evidenced by:1 2 3 4 5 6 7Uncleared individual was removed from the facility. The director was advised that individual cannot continue to work in facility until he/she gains fingerprint clearance. Civil penalties were assessed in the amount of $100.00 8 9 10 11 12 13 14Based on observations and record review the facility was found to have an uncleared indvidual on staff since Feb 2020. This poses an immediate health and safety risk to children in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 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:Alma Malig LICENSING EVALUATOR NAME:Jyoti Saini LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021

Type A citation - immediate risk to health, safety, or personal rights

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA), Jyoti Saini conducted a case management visit today along with a complaint investigation. In the course of conducting the investigation, LPA inspected the facility and observed violation of Title 22 and Health and Safety Code. At 9:47am, LPA observed an uncleared individual supervising the children. This poses an immediate health and safety risk to children in care. ***California Code of Regulations, (Title 22, Div. 12, Ch 3), are being cited on the attached LIC 809D. "NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS. LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT. An exit interview was conducted. Appeal rights were given and explained to the Director Monica Leicht. Copy of this report was reviewed and will be sent to the director at email address monicaleicht@gmail.com by the close of business on 11/19/2021. Confirmation of receipt is required. SUPERVISORS NAME: Alma Malig LICENSING EVALUATOR NAME: Jyoti Saini LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021 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 FACILITY NAME: FRIENDS OF POTRERO HILL NURSERY SCHOOL FACILITY NUMBER: 384002303 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 11/19/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type A 11/22/2021 Section Cited CCR 101170(a) 1 2 3 4 5 6 7Criminal Record Clearance(a) The Department shall conduct a criminal record review of all persons specified in Health and Safety Code Section 1596.871(b). The Department has the authority to approve or deny employment, or presence in the facility, based on the results of this review. This requirement was not met as evidenced by:1 2 3 4 5 6 7Uncleared individual was removed from the facility. The director was advised that individual cannot continue to work in facility until he/she gains fingerprint clearance. Civil penalties were assessed in the amount of $100.00 8 9 10 11 12 13 14Based on observations and record review the facility was found to have an uncleared indvidual on staff since Feb 2020. This poses an immediate health and safety risk to children in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 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:Alma Malig LICENSING EVALUATOR NAME:Jyoti Saini LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021