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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004416
Report Date: 04/13/2023
Date Signed: 04/13/2023 12:34:38 PM

Document Has Been Signed on 04/13/2023 12:34 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:WAGENHALS,KATHLEENFACILITY NUMBER:
384004416
ADMINISTRATOR:WAGENHALS, KATHLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 902-3312
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
04/13/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kathleen Wagenhals and Iustina MigneaTIME COMPLETED:
12:30 PM
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On April 13, 2023, at 11:00 a.m., an informal office meeting was conducted at the San Bruno Regional Office. Regional Manager (RM) Cindy Interiano, Licensing Program Manager (LPM) Garfield Leung, Licensing Program Analyst (LPA) Brendon Van, Licensee Kathleen Wagenhals, and Licensee's attorney, Iustina Mignea attended the meeting. The purpose of this meeting was to discuss the substantiated complaint allegation on April 7, 2023; how to ensure the health and safety of children at the Licensee's childcare home are not at risk; unusual incidents, and when and how reports should be completed.

The Regional Manager, Cindy Interiano, explained the purpose of the meeting and discussed the history of the facility. During the meeting, the Licensee discussed her plans of correction with the RM, Cindy Interiano, and LPM Garfield Leung. The Licensee's attorney explained the plan to prevent a similar violation from reoccurring and ensure that the health and safety of the children under her care are not at risk. The plans include the installation of home security and surveillance cameras and Licensee has fixed the back door and the back gate where the latch was compromised. Licensee also plans to contact the neighbor to seek additional safety measures should another similar incident occur.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: WAGENHALS,KATHLEEN
FACILITY NUMBER: 384004416
VISIT DATE: 04/13/2023
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Also discussed by RM, Cindy Interiano, and LPM Garfield Leung today with the Licensee the following:

· Discussed the adults/residents at the home and current employees associated with the facility.
· Children's rights
· The Licensing reports that required posting after the inspection, especially those reports of Type A deficiency, and LIC 9224 (Parent acknowledgment of Receipt of Licensing Reports)
· Reporting requirements; when and how reports should be completed
· The Licensee was informed that her facility would be visited more frequently by Licensing.

Submitted today by the Licensee was her written plan of correction. RM Cindy Interiano and LPM Garfield Leung reviewed the plan of correction. RM informed the Licensee that the plan would be presented to the Department's Legal team.

The report was explained to the Licensee. Today's report, April 13, 2023, and deficiency clearance letters for Type B deficiency was printed and provided to the Licensee.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC809 (FAS) - (06/04)
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