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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405645
Report Date: 10/14/2022
Date Signed: 10/14/2022 01:32:35 PM


Document Has Been Signed on 10/14/2022 01:32 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:ST. CATHERINE OF SIENA PRESCHOOLFACILITY NUMBER:
073405645
ADMINISTRATOR:MARGARET AULDFACILITY TYPE:
850
ADDRESS:1125 FERRY STTELEPHONE:
(925) 917-2003
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:42CENSUS: 23DATE:
10/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:DANA SANTIAGOTIME COMPLETED:
01:45 PM
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET TODAY WITH CENTER DIRECTOR DANA SANTIAGO FOR AN UNANNOUNCED 1 YEAR/REQUIRED INSPECTION. TODAY THERE ARE 23 PRESCHOOL AGE CHILDREN PRESENT ALONG WITH 3 STAFF MEMBERS INCLUDING DIRECTOR. THE FACILITY HAS AGE APPROPRIATE FURNITURE AND NAPPING EQUIPMENT WHICH APPEARS TO BE IN GOOD REPAIR. THE INDOOR AND OUTDOOR ACTIVITY SPACE APPEARED TO BE IN GOOD REPAIR. DISINFECTANTS, CLEANING SOLUTIONS, POISONS AND OTHER ITEMS THAT ARE DANGEROUS TO CHILDREN ARE LOCATED IN THE STAFF BATHROOM. THE SINKS/TOILETS WERE OBSERVED TO BE IN OPERABLE CONDITION. THE FLOORS ARE FREE OF TRIPPING HAZARDS. LUNCHES ARE BROUGHT FROM HOME, FACILITY PROVIDES SNACKS. THE STORAGE AREA WAS OBSERVED TO BE CLEAN AND FREE OF EVIDENCE OF RODENTS. SNACKS ARE PROTECTED AGAINST CONTAMINATION. ALL STORAGE CONTAINERS FOR SOLID WASTE HAVE TIGHT FITTING LIDS THAT ARE IN GOOD REPAIR. DRINKING WATER IS AVAILABLE BOTH INDOORS AND OUTDOORS. STUDENTS BRING THEIR OWN WATER BOTTLES. MENUS ARE POSTED NEAR THE CLASSROOMS AND VISIBLE FOR PARENTS TO REVIEW. OUTDOOR ACTIVITY SPACE AND PLAYGROUND EQUIPMENT WAS OBSERVED TO BE SAFE AND FREE OF HAZARDS WITH APPROPRIATE MATERIAL TO ABSORB FALLS. THERE ARE 3 CANOPIES ON THE PLAYGROUND TO PROVIDE SHADED AREAS FOR CHILDREN.

THE FACILITY IS OPERATING WITHIN IT'S LICENSED CAPACITY. THE FACILITY IS WITHIN RATIO TODAY. LPA DID OBSERVE 1 CHILD GO TO THE BATHROOM UNATTENDED DURING THE INSPECTION. LPA VERIFIED THAT AT LEAST 1 STAFF MEMBER HAS CURRENT CPR/1ST AID TRAINING CARDS. A PHYSICAL CENSUS WAS TAKEN OF ALL CHILDREN PRESENT AND CROSSED REFERENCED WITH THE SIGN/OUT SHEETS.

THE LICENSEE UNDERSTANDS THAT PRIOR TO WORKING OR VOLUNTEERING IN A LICENSED CHILD CARE FACILITY, ALL INDIVIDUALS SUBJECT TO CRIMINAL RECORD REVIEW SHALL OBTAIN A CLEARANCE OR CRIMINAL RECORD EXEMPTION.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ST. CATHERINE OF SIENA PRESCHOOL
FACILITY NUMBER: 073405645
VISIT DATE: 10/14/2022
NARRATIVE
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A SAMPLE OF CHILDREN'S RECORDS WERE REVIEWED. FILES REVIEWED CONTAINED EMERGENCY INFORMATION AND CURRENT IMMUNIZATION RECORDS. STAFF RECORDS WERE ALSO REVIEWED TEACHERS PRESENT TODAY MEET QUALIFICATION REQUIREMENTS.

LPA ALSO INSPECTED/FOLLOWED UP ON THE OUTLET THAT WAS REPORTED TO HAVE TESTED HIGHER THAN THE 5.5 PPB FOR LEAD. THE SINK IS LOCATED IN THE DIRECTOR'S OFFICE AND IS INACCESSIBLE TO AND NOT USED BY CHILDREN IN CARE.

Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ST. CATHERINE OF SIENA PRESCHOOL
FACILITY NUMBER: 073405645
VISIT DATE: 10/14/2022
NARRATIVE
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at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

PLEASE SEE 809-D FOR CITATION



An exit interview was conducted. A notice of site visit was posted.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 10/14/2022 01:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: ST. CATHERINE OF SIENA PRESCHOOL
FACILITY NUMBER: 073405645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229(a)(1)
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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
TIHS REQUIREMENT WAS NOT MET AS EVIDENCED BY: A CHILD WAS OBSERVED GOING TO THE BATHROOM UNATTENDED BY STAFF
POC Due Date: 10/31/2022
Plan of Correction
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FACILITY WILL ENSURE THAT CHILDREN ARE SUPERVISED AT ALL TIMES/CHILDREN MUST BE ESCORTED TO/FROM THE BATHROOM. LICENSEE WILL HAVE A STAFF TRAINING ON CHILD SUPERVISION. LICENSEE WILL SUBMIT PROOF OF TRAINING AND WHO ATTENDED TO COMMUNITY CARE LICENSING BY 10/31/22. VIDEOS ON CHILD SUPERVISION CAN BE FOUND ON CCL WEBSITE.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY: A REVIEW OF STAFF RECORDS REVEALED, ALL FLU VACCINES ARE NOT UP TO DATE
POC Due Date: 10/31/2022
Plan of Correction
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ALL STAFF WILL SUBMIT PROOF AN UP TO DATE FLU VACCINATION OR DECLARATION BY 10/31/22

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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 10/14/2022 01:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: ST. CATHERINE OF SIENA PRESCHOOL
FACILITY NUMBER: 073405645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(c)
Administration of Child Day Care Licensing
(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT IS NOT MET AS EVIDENCED BY: TODAY STAFF MEMBER MS. KAILEY'S MANDATED REPORTER TRAINING CERTIFICATE IS EXPIRED
POC Due Date: 10/31/2022
Plan of Correction
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LICENSEE SHALL ENSURE THAT STAFF MEMBER UPDATE THE MANDATED REPORTER TRAINING AND SUBMIT A COPY OF THE CERTIFICATE TO COMMUNITY CARE LICENSING BY 10/31/22
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY : TODAY STAFF MEMBER KAITLYN G. DOES NOT HAVE THE HEALTH SCREENING FORM IN FILE
POC Due Date: 10/31/2022
Plan of Correction
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LICENSEE WILL ENSURE THAT THE STAFF MEMBER OBTAIN A HEALTH SCREENING FROM A PHYSICIAN AND SUBMIT A COPY TO COMMUNITY CARE LICENSING BY 10/31/22.

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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6