210102934-7-16-2019-05-CC-BVAN-BE5PF9-20190716111622

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210102934
Report Date: 07/16/2019
Date Signed: 07/16/2019 11:16:34 AM

COMPREHENSIVE INSPECTION

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:	SAUSALITO NURSERY SCHOOL		FACILITY NUMBER:	210102934
ADMINISTRATOR:	MILLER, DIANA		FACILITY TYPE:	850
ADDRESS:	625 MAIN STREET		TELEPHONE:	(415) 332-0174
CITY:	SAUSALITO	STATE: CA	ZIP CODE:	94965
CAPACITY:	40	CENSUS: 9	DATE:	07/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Bernstein Diane		TIME COMPLETED:	11:20 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Van met with Assistant Director, Bernstein Diane for an unannounced annual visit today at this facility. Also present are 9 children 3 teachers, and a helper. This co-op program, this school is in summer schedule: 9am - 1pm. Director, Diana Miller arrived during the inspection. LPA along with director inspected the center for health and safety. The center is clean and orderly. Heating, lighting & ventilation are adequate. There are no pools, spas or other bodies of water on the premises. Per director, there are no firearms or weapons at the center. All cleaning supplies or other potentially harmful items are stored inaccessible to the children in care. This center provides Incidental Medical Service (IMS). LPA reviewed storage and paperwork requirements with staff. LPA requested an IMS plan, Director will submit to licensing on a later date. The furniture and equipment are in good repair and is free from loose sharp or pointed parts. The food prep area is clean and organized with food stored appropriately. Parents provide snacks for the children. All solid waste storage containers have tight fitting lids. The facility has more than one carbon monoxide detector and smoke alarm installed. Drinking water is provided to the children water bottles brought from home. Cubbies are used to store children's belongings, and each cubby has child’s name labeled. Children bathroom has a sink with 3 faucets and 3 toilets. Toilets and sinks are reachable by children. all restrooms are clean, in good repair, and maintain adequate supplies. The water temperature is adequate. There is a separate staff restroom. The isolation area for an ill child is located in the Director’s office. The toilet and sink designated for an ill child is in the staff restroom. The outside play area is completely fenced, clean and in good repair. The playground is free of hazardous materials. Play equipment is age appropriate, and safe. Climbing structures are securely anchored, free of any loose parts and has sufficient amounts of wood-chipped cushioning floor to prevent any fall injuries. Outdoor drinking water is accessible by water fountains. Continue on the next page.........................

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAUSALITO NURSERY SCHOOL	FACILITY NUMBER: 210102934
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/23/2019 Section Cited CCR 101170(e)	1 2 3 4 5 6 7	101170- Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code continue below....	1 2 3 4 5 6 7	Director states she will have the helper to get the livescan done today. Director is also asked Helper to leave the facility until the fingerprint clearance is clear. Director will have the helper fingerprinted by POC due date.
	8 9 10 11 12 13 14	Section 1596.871 shall prior to working, residing or volunteering in a licensed facility. This requirement is not met evidenced by director was unable to provide any documentation from the helper. Helper was stayed at the facility for couple weeks had contact with children and did not have fingerprint clearance. This poses an immediate Health and Safety or Personal Rights risk to the children in care. Civil Penalty of $100 was issued.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 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	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAUSALITO NURSERY SCHOOL	FACILITY NUMBER: 210102934
	VISIT DATE: 07/16/2019

NARRATIVE

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LPA reviewed personnel and children records. A sample of children's files were reviewed and found to have medical assessments, needs/services, and signed admission agreements. Staff files are organized, complete, and have documentation of education credits. Multiple staff members have record of valid CPR card in files and documentation of immunization for Measles, Pertussis and Influenza. LPA also observed facility has posted the required forms (i.e. License, menus, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Director stated Fire and Earthquake drills are done every month, last drill was logged on 6/4/19.

LPAs reminded the director that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles. LPA observed the facility has record of required immunization for all staff members.

LPA reviewed AB 1207 with the director. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed all staff members completed the online training, and certification are in file.

A Type “A” violation (see continuation) was issued today. The center is informed to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report and appeal rights were provided and reviewed with the licensee. Notice of Site Visit shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

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