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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406683
Report Date: 03/16/2023
Date Signed: 03/16/2023 06:09:15 PM


Document Has Been Signed on 03/16/2023 06:09 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:WOOD ROSE ACADEMY AND PRESCHOOLFACILITY NUMBER:
073406683
ADMINISTRATOR:HARISDELSY CARDENASFACILITY TYPE:
850
ADDRESS:4347 COWELL ROADTELEPHONE:
(925) 825-4644
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:72CENSUS: 53DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:HARISDELSY CARDENASTIME COMPLETED:
06:15 PM
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8:15AM- LICENSING PROGRAM ANALYST TASHA ALEXANDER MET TODAY WITH CENTER DIRECTOR HARISDELSY CARDENAS FOR AN UNANNOUNCED 1 YEAR/REQUIRED INSPECTION. TODAY THERE ARE 53 PRESCHOOL AGE/INFANT TODDLER CHILDREN PRESENT ALONG WITH 10 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 WERE INACCESSIBLE DURING TODAY'S INSPECTION. THE SINKS WERE OBSERVED TO BE IN OPERABLE CONDITION. THE FLOORS ARE FREE OF TRIPPING HAZARDS. BREAKFAST, LUNCH AND SNACKS ARE PROVIDED BY THE FACILITY. THE KITCHEN WAS OBSERVED TO BE CLEAN AND FREE OF EVIDENCE OF RODENTS. FOOD/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. CHILDREN BRING THEIR OWN WATER BOTTLES FROM HOME. MENUS ARE POSTED 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 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 NOT OBSERVE ANY CHILD LEFT WITHOUT SUPERVISION DURING INSPECTION. LPA VERIFIED THAT AT LEAST ONE STAFF HAS CURRENT CPR/1ST AID TRAINING. 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: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: WOOD ROSE ACADEMY AND PRESCHOOL
FACILITY NUMBER: 073406683
VISIT DATE: 03/16/2023
NARRATIVE
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A SAMPLE OF CHILDREN'S RECORDS WERE REVIEWED. FILES REVIEWED CONTAINED EMERGENCY INFORMATION AND CURRENT IMMUNIZATION RECORDS. STAFF RECORDS REVIEWED. TEACHERS PRESENT TODAY MEET QUALIFICATION REQUIREMENTS.

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: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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: WOOD ROSE ACADEMY AND PRESCHOOL
FACILITY NUMBER: 073406683
VISIT DATE: 03/16/2023
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 THE ATTACHED 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: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 03/16/2023 06:09 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: WOOD ROSE ACADEMY AND PRESCHOOL
FACILITY NUMBER: 073406683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 RECORDS- STAFF MEMBERS ESPERANZA PEREZ, NANCY VALDOVINO, CLAUDIA RUIZ, ROXANA CARRASCO, MARIA AND MARIA PINHO DO NOT HAVE IMMUNIZATION RECORDS IN FILE.
POC Due Date: 04/06/2023
Plan of Correction
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LICENSEE WILL HAVE STAFF OBTAIN THEIR IMMUNIZATION RECORDS AND LICENSEE WILL SUBMIT COPIES TO COMMUNITY CARE LICENSING BY 4/6/2023. RECORDS MUST SHOW PROOF OF MEASLES, PERTUSSIS AND FLU VACCINES OR FLU DECLARATION.
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.THS REQUIREMENT WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS- TODAY STAFF MEMBERS ESPERANZA PEREZ, NANCY VALDOVINO, CLAUDIA RUIZ, ROXANA CARRASCO, MARIA SOLANO AND MARIA PINHO DO NOT HAVE THE MANDATED REPORTER CERTIFICATE IN FILE OR IS EXPIRED
POC Due Date: 03/30/2023
Plan of Correction
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LICENSEE WILL HAVE STAFF UPDATE THEIR MANDATED REPORTER TRAINING AND LICENSEE WILL SUBMIT COPIES OF THE UPDATED CERTIFICATES TO COMMUNITY CARE LICENSING BY 3/30/23.
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: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 03/16/2023 06:09 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: WOOD ROSE ACADEMY AND PRESCHOOL
FACILITY NUMBER: 073406683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 A REVIEW OF RECORDS- STFF MEMBERS ESPERANZA PEREZ AND ROXANA CARRASCO DO NOT HAVE THE REQUIRED HEALTH SCREENING REPORT IN FILE
POC Due Date: 04/06/2023
Plan of Correction
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LICENSEE WILL HAVE STAFF MEMBERS OBTAIN A HEALTH SCREENING FROM THEIR PHYSICIAN AND SUBMIT A COPY OF THE REPORT TO COMMUNITY CARE LICENSING BY 4/6/2023.
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

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 RECORDS- STAFF MEMBEREXPERANZA PEREZ DOES NOT HAVE A SIGNED EMPLOYEE RIGHTS RECEIPT IN FILE
POC Due Date: 03/30/2023
Plan of Correction
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LICENSEE WILL HAVE STAFF ESPERANZA SIGN THE EMPLOYEE RIGHTS FORM AND LICENSEE WILL SUBMIT A COPY OF THE SIGNED RECEIPT TO COMMUNITY CARE LICENSING BY 3/30/23
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: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 03/16/2023 06:09 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: WOOD ROSE ACADEMY AND PRESCHOOL
FACILITY NUMBER: 073406683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

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 RECORDS- TODAY THERE IS ONC CHILD THAT DOES NOT HAVE THE PHYSICIAN'S REPORT IN FILE
POC Due Date: 03/30/2023
Plan of Correction
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LICENSEE WILL HAVE THE CHILD'S PARENT/GUARDIAN OBTAIN A EXAM/PHYSICIAN'S REPORT FROM THE CHILD'S DOCTOR.WILL SUBMIT A COPY OF THE REPORT TO COMMUNITY CARE LICENSING BY 3/30/23
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

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 RECORDS- TODAY 2 CHILDREN DO NOT HAVE THE PERSONAL RIGHTS RECEIPT IN FILE NOR THE PARENT'S RIGHTS RECEIPT IN FILE
POC Due Date: 03/30/2023
Plan of Correction
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LICENSEE WILL HAVE EACH CHILD'S PARENT/GUARDIAN SIGN THE PARENT'S RIGHTS AND PERSONAL RIGHTS FORMS. LICENSEE WILL SUBMIT COPIES OF THE FORMS TO COMMUNITY CARE LICENSING BY 3/30/23
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: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6