280100646-5-20-2024-01-CC-MMOR-D5FQQ7-20240520122153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 280100646
Report Date: 05/20/2024
Date Signed: 05/20/2024 12:22:12 PM

Document Has Been Signed on 05/20/2024 12:22 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:	PRESBYTERIAN DAY SCHOOL		FACILITY NUMBER:	280100646
ADMINISTRATOR:	BATOR, JENNIFER		FACILITY TYPE:	850
ADDRESS:	1333 THIRD STREET		TELEPHONE:	(707) 224-8941
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	44	CENSUS: 21	DATE:	05/20/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Jennifer Bator		TIME COMPLETED:	12:30 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	An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Mindy Mohr in response to a self-reported, lack of supervision incident involving Child (C1) and Child (C2) that occurred on 05/13/2024. During today's visit LPA met with Director Jennifer Bator (D1) to discuss the incident. It was reported that on 05/13/2024 while the children were outside in the big play yard C1 and C2 opened a latched gate and walked out of the big play yard to the front of building. D1 stated the children walked through the alley between the school and the business next door, and then through another gate which was propped open for the roof workers. D1 stated the children stopped on the sidewalk and stood by a 2 hr parking sign which is located approximately five feet from the outside gate and between the school and the business next door. D1 stated the building is having the roof replaced , and one of the roof workers saw C1 an C2 and took them to the business next door which also serves parents and children of the community. An employee of that business returned the children to the school immediately and spoke with D1. D1 stated that this incident was reported to the children's authorized representatives immediately. D1 notified CCLD by telephone on the day of the incident. D1 stated that there were 19 children on the play yard, with 3 staff. LPA observed an alarm has been installed on the gate which activates when the gate opens. D1 stated she has contacted the Fire Department for guidance on installing a different gate that can be used, that is child proof but also passes fire inspection as that is one of the schools emergency exits. D1 also stated that they will be discussing the incident along with the importance of supervision at all times at their next staff meeting. Continued on LIC809-C

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda Mohr	TELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024

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: PRESBYTERIAN DAY SCHOOL	FACILITY NUMBER: 280100646
	VISIT DATE: 05/20/2024

NARRATIVE

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Based on staff interview, it has been determined that preschool staff did not provide adequate supervision to children C1 and C2 during the incident on 05/13/2024. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D.

The following violations of the California Code of Regulations, Title 22; Division 12: see LIC 9099D. A civil penalty of $500 is being assessed. Appeal rights were provided.

Exit interview was conducted which documents one Type A citation and was reviewed with Director, Jennifer Bator who was informed that Type A citations shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

LPA Mohr informed the facility representative to provide a copy of this licensing report dated 05/20/2024 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 enrolling 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.

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.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda Mohr	TELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/20/2024 12:22 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: PRESBYTERIAN DAY SCHOOL	FACILITY NUMBER: 280100646
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/20/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/20/2024 Section Cited HSC 1596.99(c)(3)	1 2 3 4 5 6 7	Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of ageThis requirement is not met as evidenced by:	1 2 3 4 5 6 7	An alarm has already been installed on the gate out in the play yard. D1 will discuss the importance of supervision at their next staff meeting. D1 will work with the fire department on compliance with installing a new gate in the play yard. D1 will contact LPA M. Mohr once she has talked with the Fire department regarding whether or not the gate can be installed via telephone or email : melinda.mohr@dss.ca.gov
	8 9 10 11 12 13 14	Based on the Director's own admission on 05/13/24 child C1 and child C2 was left without staff supervision for approximately 5 minutes while they wandered out to the street from the big play yard. This posed an immediate health and safety risk to the child(ren) in care.	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: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda Mohr	TELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024

LIC809 (FAS) - (06/04)

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