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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233006510
Report Date: 05/15/2024
Date Signed: 05/15/2024 05:09:46 PM

Document Has Been Signed on 05/15/2024 05:09 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:DEEP VALLEY CHRISTIAN SCHOOLFACILITY NUMBER:
233006510
ADMINISTRATOR/
DIRECTOR:		KILPATRICK, DASHAFACILITY TYPE:
850
ADDRESS:8555 UVA DRIVETELEPHONE:
(707) 485-8778
CITY:REDWOOD VALLEYSTATE: CAZIP CODE:
95470
CAPACITY: 50TOTAL ENROLLED CHILDREN: 30CENSUS: 21DATE:
05/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:06 PM
MET WITH:Dasha KilpatrickTIME VISIT/
INSPECTION COMPLETED:
05:19 PM
NARRATIVE
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A required annual inspection of the facility was conducted by Licensing Program Analyst (LPA) Robert Maciel, who met with Director Dasha Kilpatrick. The facility file was reviewed prior to this inspection. LPA observed that two staff working in the facility, staff 5 (S5) and staff 6 (S6), did not possess criminal record clearances from the Department of Social Services. 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 from 7:30 AM - 5:30 PM Monday-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. LPA observed that the sign-in and sign-out sheets contained parent signatures that did not use their full legal signature. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be out of reach, inaccessible to children. Director stated poisons are stored in the janitor's closet which is locked. 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 individual water bottles. The children's bathrooms are in safe and sanitary condition. The facility does not provide lunch, lunch for children is brought from home. Garbage cans containing solid waste have tight fitting lids. LPA observed a working smoke alarm, carbon monoxide detector, and fire extinguisher rated at least 2A10BC in the facility. Last emergency drill was conducted on 5/10/24. Continued on LIC809-C.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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: DEEP VALLEY CHRISTIAN SCHOOL
FACILITY NUMBER: 233006510
VISIT DATE: 05/15/2024
NARRATIVE
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The playground equipment and surface areas are in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There are no bodies of water observed on the site. Director stated no weapons are stored on site, and none were observed. During today's inspection, staffing ratios were being met, and 21 children were supervised by 6 staff. The facility was operating within the licensed capacity and ratio requirements. At least one staff member present during the inspection possessed current CPR and First Aid certifications, which expire in August 2024. Five children’s records were reviewed at 2:39 PM which contained all records as required. Six staff records were reviewed at 3:12 PM which revealed that staff 5 (S5) and staff 6 (S6) did not possess a complete health screening. During file review, LPA observed that lead testing had not been complete in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA referred director 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. 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/.

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.

Continued on LIC 809C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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: DEEP VALLEY CHRISTIAN SCHOOL
FACILITY NUMBER: 233006510
VISIT DATE: 05/15/2024
NARRATIVE
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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, Dasha Kilpatrick. A notice of site visit was given and must remain posted for 30 days.

LPA informed Director, Dasha Kilpatrick that this report dated 05/15/2024 documents one Type A citation. Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the Director to provide a copy of this licensing report dated 05/15/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 05/15/2024 05:09 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/15/2024 at 04:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: DEEP VALLEY CHRISTIAN SCHOOL
FACILITY NUMBER: 233006510

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, staff 5 (S5) and staff 6 (S6) did not possess a criminal record clearance from the Department of Social Services which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Director stated she would ensure S5 and S6 both obtain criminal record clearances and send LPA a copy of the receipts by email at robert.maciel@dss.ca.gov. DIrector stated that both staff would not return to the facility until clearances are obtained.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/15/2024 05:09 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/15/2024 at 04:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: DEEP VALLEY CHRISTIAN SCHOOL
FACILITY NUMBER: 233006510

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
WD
101700(b)
Written Directives for Lead Testing
(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not complete lead testing had not been complete in accordance to the Written Directives outlined in PIN 21-21.1-CCP which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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Director stated she would complete lead testing for the facility and send proof to LPA by email at robert.maciel@dss.ca.gov.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], staff 5 (S5) and staff 6 (S6) did not possess complete health screeenings which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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Director stated she would obtain both health screenings 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
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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