233002800-2-21-2024-01-CC-RMAL-D2P392-20240221170225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 233002800
Report Date: 02/21/2024
Date Signed: 02/21/2024 05:02:42 PM

Document Has Been Signed on 02/21/2024 05:02 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	GLASS BEACH - PRESCHOOL		FACILITY NUMBER:	233002800
ADMINISTRATOR:	SHEA, MARTHA		FACILITY TYPE:	850
ADDRESS:	930 STEWART STREET		TELEPHONE:	(707) 961-9611
CITY:	FORT BRAGG	STATE: CA	ZIP CODE:	95437
CAPACITY:	35	CENSUS:	DATE:	02/21/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Martha Shea		TIME COMPLETED:	01:24 PM

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	A required annual inspection of the facility was conducted by Licensing Program Analyst (LPA) Robert Maciel, who met with Director Martha Shea. The facility file was reviewed prior to this inspection. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. The facility’s operating hours are 7:45 AM - 5:15 PM, Monday-Thursday and 7:45 AM - 1 PM on Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The sign-in/sign-out records were reviewed which revealed that parents were not using their signatures to sign in and out. The director stated that the policy of the facility since the pandemic was to have staff sign in and out the children instead of the parents to limit the spread of disease. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Director stated poisons are stored in the laundry room which was observed to be locked by the LPA. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children indoors and outdoors by use of water bottles and cups. The children's bathrooms are in safe and sanitary condition. Director stated that lunch is brought from home and the facility provides snacks. 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. LPA observed a working carbon monoxide detector, smoke alarm, and fire extinguisher rated at least 2A10BC in the facility. The licensee has conducted an emergency drill within the past six months, most recent drill was documented on 12/7/23. Continued on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert Maciel	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GLASS BEACH - PRESCHOOL	FACILITY NUMBER: 233002800
	VISIT DATE: 02/21/2024

NARRATIVE

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The playground equipment and surface areas are in safe condition. There is wood chip and peat gravel cushioning underneath climbing structures and/or play equipment to absorb falls. There was a small puddle in the sand box that the director stated was filled by the recent rain. Director stated she was going to fill in the box with more sand so that a body of water does not form. Director stated no weapons are stored on site, and none were observed. During today's inspection, staffing ratios were being met, and 16 children were supervised by 2 staff. The facility was operating within the licensed capacity and ratio requirements. 1 staff member present during the inspection possessed a current CPR and First Aid certification which expires 6/3/24. Two staff records were reviewed at 1:19 PM and which revealed that staff 1 (S1) did not possess a current mandated reporter training certificate, a record of immunization against measles, pertussis, and influenza, staff 2 (S2) did not possess a current mandated reporter training certificate, and the director could not produce the staff file for staff 3 (S3). Five children’s records were reviewed at 12:06 PM which revealed that child 1 - child 5 (C1-C5) did not have their immunizations recorded onto the CDPH 286 form, C3's parent's rights form was missing, and C5's physician's report was incomplete.

LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Continued on LIC 809C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert Maciel	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GLASS BEACH - PRESCHOOL	FACILITY NUMBER: 233002800
	VISIT DATE: 02/21/2024

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The following violations of the California Code of Regulation, Title 22, Division 12, were cited: see LIC809-D. Appeal Rights were provided. Exit interview conducted and report was reviewed with the Director Martha Shea. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert Maciel	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/21/2024 05:02 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GLASS BEACH - PRESCHOOL	FACILITY NUMBER: 233002800
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the director stated that the facility was not yet tested for lead contamination in faucets used for drinking and and food preparation which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2024
	Plan of Correction
1 2 3 4	Director stated that she would begin the lead testing process and send proof of progress to LPA by email at robert.maciel@dss.ca.gov.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, no staff present at the facility possessed a current mandated reporter training certificate which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2024
	Plan of Correction
1 2 3 4	Director stated she would ensure all staff would obtain a current mandated reporter training certificate and send a copy of each to LPA by email at robert.maciel@dss.ca.gov.

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 Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert Maciel	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC809 (FAS) - (06/04)

Page: 4 of 8

Document Has Been Signed on 02/21/2024 05:02 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GLASS BEACH - PRESCHOOL	FACILITY NUMBER: 233002800
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2024

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
1 2 3 4	Based on record review, staff 1 (S1) did not possess a record of immunization against measles, pertussis, and influenza which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2024
	Plan of Correction
1 2 3 4	Director stated she would obtain the immunization records and send a copy to LPA by email at robert.maciel@dss.ca.gov

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, there was not a staff file for staff 3 (S3) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2024
	Plan of Correction
1 2 3 4	Director stated she would recreate the staff's file and send a copy of the complete file to LPA by email at robert.maciel@dss.ca.gov.

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 Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert Maciel	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC809 (FAS) - (06/04)

Page: 5 of 8

Document Has Been Signed on 02/21/2024 05:02 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GLASS BEACH - PRESCHOOL	FACILITY NUMBER: 233002800
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2024

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
1 2 3 4	Based on record review, child 5 (C5) physician's report was incomplete which poses a potential health, safety or personal rights risk to persons in care..
	POC Due Date: 03/21/2024
	Plan of Correction
1 2 3 4	Director stated she would obtain a completed physician's report from C5's parents and send a copy to LPA by email at robert.maciel@dss.ca.gov

Type B

Section Cited

CCR

101221(a)

Child's Records

(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, child 3's (C3) parent's rights form was missing which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2024
	Plan of Correction
1 2 3 4	Director stated she would obtain the signed parent's rights form and send a copy to LPA by email at robert.maciel@dss.ca.gov

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 Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert Maciel	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC809 (FAS) - (06/04)

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