SFUSD-COMMODORE STOCKTON EARLY ED SCHOOL (PS)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On March 01, 2024 at approximately 10:05am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit for a self reported Unusual Incident that was reported to the department on 02/16/2024 and met with Principal, Jenny Yu during the visit. Purpose of the inspection was explained. There were 10 staff caring for 57 children during the visit. During today's visit, LPA interviewed the Principal to obtain detail information into the Unusual Incident. Based on information collected, a child was left in the children's restroom alone for an approximate 1 minute until the staff came back for child. Child's parent was notified of the incident. Since the incident, Principal had conducted staff meeting to remind staff regarding 100% supervision of children at all time. In addition, involved staff was subjected to a written reprimand for the lack of supervision. This self reported incident is deemed as the lack of supervision. Staff left a child in the restroom poses a potential health and safety risk to persons in care. Type B violation has been issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D. A copy of this report and appeal rights were discussed and left with Principal whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. SUPERVISORS NAME: Garfield Leung LICENSING EVALUATOR NAME: Winnie Ly LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024 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: SFUSD-COMMODORE STOCKTON EARLY ED SCHOOL (PS) FACILITY NUMBER: 384002514 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/01/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/15/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7101229(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 is not met as evidenced by: 1 2 3 4 5 6 7Prinicipal submitted proof of conducting a meeting with involved staff. 8 9 10 11 12 13 14Based on self reported unusual incident and detail information collected during visit, staff left a child in the restroom for an approximate 1 minute poses a potential health and safety risk to persons in care.8 9 10 11 12 13 14This deficiency is considered corrected and cleared as of today. 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:Garfield Leung LICENSING EVALUATOR NAME:Winnie Ly LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On March 01, 2024 at approximately 10:05am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Case Management Visit for a self reported Unusual Incident that was reported to the department on 02/16/2024 and met with Principal, Jenny Yu during the visit. Purpose of the inspection was explained. There were 10 staff caring for 57 children during the visit. During today's visit, LPA interviewed the Principal to obtain detail information into the Unusual Incident. Based on information collected, a child was left in the children's restroom alone for an approximate 1 minute until the staff came back for child. Child's parent was notified of the incident. Since the incident, Principal had conducted staff meeting to remind staff regarding 100% supervision of children at all time. In addition, involved staff was subjected to a written reprimand for the lack of supervision. This self reported incident is deemed as the lack of supervision. Staff left a child in the restroom poses a potential health and safety risk to persons in care. Type B violation has been issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D. A copy of this report and appeal rights were discussed and left with Principal whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. SUPERVISORS NAME: Garfield Leung LICENSING EVALUATOR NAME: Winnie Ly LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024 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: SFUSD-COMMODORE STOCKTON EARLY ED SCHOOL (PS) FACILITY NUMBER: 384002514 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 03/01/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/15/2024 Section Cited CCR 101229(a)(1) 1 2 3 4 5 6 7101229(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 is not met as evidenced by: 1 2 3 4 5 6 7Prinicipal submitted proof of conducting a meeting with involved staff. 8 9 10 11 12 13 14Based on self reported unusual incident and detail information collected during visit, staff left a child in the restroom for an approximate 1 minute poses a potential health and safety risk to persons in care.8 9 10 11 12 13 14This deficiency is considered corrected and cleared as of today. 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:Garfield Leung LICENSING EVALUATOR NAME:Winnie Ly LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024

Type B citation - potential risk if not corrected