210106761-3-9-2022-05-CC-HRCO-CCD33V-20220309165409

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210106761
Report Date: 03/09/2022
Date Signed: 03/09/2022 05:03:35 PM

Document Has Been Signed on 03/09/2022 05:03 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CHILDREN'S COTTAGE CO-OP.		FACILITY NUMBER:	210106761
ADMINISTRATOR:	HEIDI NETTZ		FACILITY TYPE:	850
ADDRESS:	2900 LARKSPUR LANDING		TELEPHONE:	(415) 461-0822
CITY:	LARKSPUR	STATE: CA	ZIP CODE:	94939
CAPACITY:	25	CENSUS: 13	DATE:	03/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Heidi Nettz		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) Haydee Caliboso met with Heidi Nettz (Director) to conduct an unannounced annual inspection on 03/09//22. LPA arrived at the facility at 9:05AM. The purpose of the inspection was explained. Present during the inspection were 13 children, Director, and 2 parent volunteers. Facility is operating within the capacity and is following staff child ratio. All parent volunteers have been fingerprint cleared. Facility operates Monday – Friday, 9:00AM to 2:00PM. The facility was inspected today, indoors and outdoors for health and safety hazards. LPA observed no bodies of water at the facility. Director stated there are no firearms or weapons in the facility. The facility is equipped with smoke detector, carbon monoxide detectors, fully charged fire extinguishers and a working telephone available. The classrooms have adequate ventilation and lighting. LPA observed all cleaning solutions, poisons and other chemicals that are dangerous to the children are stored made inaccessible to the children. The classrooms are equipped with age-appropriate toys and furniture. The furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. LPA observed toilets and hand washing equipment are in working condition with proper sanitation in place. All storage containers for solid waste and in good repair and have proper tight fitted lid on top. The program has drinking water available for children for indoors and outdoors. Outdoor play area equipped with toys that are age appropriate and in good working condition. First aid kit and emergency supplies are properly maintained and kept inaccessible to children. Director stated that there are no children in the program who currently have medications in care. Cont. 809-C pg. 2

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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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Document Has Been Signed on 03/09/2022 05:03 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHILDREN'S COTTAGE CO-OP.	FACILITY NUMBER: 210106761
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Deficiency Dismissed

Type A

Section Cited

CCR

101229(a)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in the facility failed to ensure no children be left without supervision which poses an immediate health, safety or personal rights risk to persons in care. C1 went back inside the classroom to use the restroom without supervision while all children, staff, and parent volunteers are outside area.
	POC Due Date: 03/18/2022
	Plan of Correction
1 2 3 4	Facility will create Plan of Correction (POC) in correcting the deficiency. S1 was informed about the incident and was given a verbal and written warning. S1 will conduct a staff meeting and inform all the parents in the program by 3/11/22 emphasizing the importance of children safety through visual and active supervision and to ensure head counts are conducted. S1 will send LPA POC by 3/18/22.

Request Denied

Type A

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in the facility failed to ensure no children be left without supervision which poses an immediate health, safety or personal rights risk to persons in care. C1 went back inside the classroom to use the restroom without supervision while all children, staff, and parent volunteers are outside area.
	POC Due Date: 03/18/2022
	Plan of Correction
1 2 3 4	Facility will create Plan of Correction (POC) in correcting the deficiency. S1 was informed about the incident and was given a verbal and written warning. S1 will conduct a staff meeting and inform all the parents in the program by 3/11/22 emphasizing the importance of children safety through visual and active supervision and to ensure head counts are conducted. S1 will send LPA POC by 3/18/22.

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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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: CHILDREN'S COTTAGE CO-OP.	FACILITY NUMBER: 210106761
	VISIT DATE: 03/09/2022

NARRATIVE

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LPA reviewed personnel and children’s files during today’s inspection. LPA observed all files are complete and up-do-date. LPA observed facility has record of names, addresses and telephone numbers of each child 's authorized representative. Each child's record contains the record immunization. Staff members have record of valid First Aid CPR card in file. LPA reviewed the educational qualification of all the teachers. Facility has a log for emergency drills being conducted. Per log, last emergency drill was conducted on 02/2022. Director the program is not providing transportation.

The Director was reminded about Mandated Reporter training available on the CCLD website. In addition to the AB1207 training must be completed every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. During the inspection, LPA observed staff have completed the child abuse training. A copy of training certificate was kept in file. Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA informed the Director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For rules and regulations, visit the website: www.cdss.ca.gov

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.
Cont. 809-C pg. 3

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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: CHILDREN'S COTTAGE CO-OP.	FACILITY NUMBER: 210106761
	VISIT DATE: 03/09/2022

NARRATIVE

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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

The report was emailed and reviewed by the Director, Heidi Nettz. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was emailed to Heidi Nettz. Today’s report and notice of site visit will be sent to the Director by the end of the day on 03/08/22. Confirmation of receipt is required.

As a result, the following Title 22 deficiency is being cited on the next page. An exit interview was conducted; Plans of corrections were reviewed and developed with the Director. Appeal Rights were provided and discussed with the Director. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and 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.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

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