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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102885
Report Date: 01/24/2020
Date Signed: 01/24/2020 01:52:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ROSS VALLEY NURSERY SCHOOLFACILITY NUMBER:
210102885
ADMINISTRATOR:ANSTEY, KATHLEENFACILITY TYPE:
850
ADDRESS:689 SIR FRANCIS DRAKE BLVD.TELEPHONE:
(415) 461-5150
CITY:KENTFIELDSTATE: CAZIP CODE:
94904
CAPACITY:40CENSUS: 26DATE:
01/24/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Kathleen (Kathy) AnsteyTIME COMPLETED:
02:10 PM
NARRATIVE
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An annual required inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have not received criminal record and child abuse index clearances or exemptions. LPA Strother arrived to the facility at 9:19am and completed a census count of the children and took note of the staff working with the children. Upon record review LPA noted that substitute teacher (S1), a former director of the school, was no longer actively fingerprint cleared or associated to the facility. The director stated that S1 has substituted for four days this week, 01/14/20, 01/20/20, 01/23/2020 and 01/24/2020. When LPA was able to verify that S1 did not have an active finger print clearance, the director excused S1 from the classroom after confirming that the ratio requirements were being met without S1's presence.

The facility’s operating hours are 8:30am-4:15pm, Monday -Thursday and 8:30am-12:00pm Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. The director stated that no poisons are stored on the premises and none were observed during today's inspection. The toys, floors, tables and other equipment and surfaces are clean, toxic free, safe and in good condition. There is drinking water available to children both indoors with disposable cups for water and outdoors with a drinking fountain. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. The LPA observed a carbon monoxide detector in the facility, but it was non-operational when tested. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The director stated no weapons are stored on site and none were observed.
Continue on LIC809-C
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ROSS VALLEY NURSERY SCHOOL
FACILITY NUMBER: 210102885
VISIT DATE: 01/24/2020
NARRATIVE
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 During today's inspection, staffing ratios were being met, and 26 children were being supervised by 6 teachers/aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (S2) possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Five children’s records were reviewed at 11:40am, and contained signed admission agreements. Two staff records were reviewed at 12:38pm and contained documentation of education and training as required. This facility is providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Director. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. The director stated that the facility does not currently have a written Plan of Operation for providing IMS on file, and will use the handout provided by LPA Strother as a guide to create a Plan of Operation for providing IMS and submit it to the San Bruno Licensing Regional Office for review. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochure, were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D.

Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.



An exit interview was conducted and Plans of corrections were reviewed and developed with the Licensee. Appeal Rights were provided and discussed with the Director, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ROSS VALLEY NURSERY SCHOOL
FACILITY NUMBER: 210102885
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2020
Section Cited

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Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these
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This requirement is not met as evidenced by: LPA tested the carbon monoxide detector that was pluged into the wall and it was not functioning. The director stated that they do not have a another carbon monoxide detector and this one appears to not work any longer. This poses an potential risk to the children in care.
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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ROSS VALLEY NURSERY SCHOOL
FACILITY NUMBER: 210102885
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2020
Section Cited

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(e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working,... in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department
This requirement is not met as evidenced by:
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Based on record review and interview, the licensee did not make sure that S1 was criminal record cleared and associated to the facility prior to working in a licensed child care facility which poses an immediate Health, Safety, or Personal Rights risk to children in care.
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S1 will complete the LiveScan form and complete the LiveScan fingerprint process today 01/24/2020.

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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4