480101919-5-29-2019-01-CC-MAUN-BCMR9A-20190529124912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480101919
Report Date: 05/29/2019
Date Signed: 05/29/2019 12:49:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	NORTH HILLS CHRISTIAN SCHOOL		FACILITY NUMBER:	480101919
ADMINISTRATOR:	LUDEZA PARINAS		FACILITY TYPE:	850
ADDRESS:	200 ADMIRAL CALLAGHAN LANE		TELEPHONE:	(707) 644-5284
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	132	CENSUS: 78	DATE:	05/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Ludeza Parinas		TIME COMPLETED:	01:00 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 Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. The facility file was reviewed prior to this visit. 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. This program is not a Title 5 funded program. The facility has a waiver that allows children to be electronically signed in/out. The facility’s operating hours are 6:00am - 6:00pm, Monday-Friday; in room B101- B104 and A101-A102. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. LPA did not observe any poisons. The facility was free of flies, insects and rodents. 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 both indoors and outdoors near the children's sink. There are water fountains located near the children's sink fixture. The children's bathrooms are in safe and sanitary condition. A current menu was posted on parent board in each classroom. Food prep areas are clean. Food is properly stored and refrigerated as needed. AM/PM snack is provided by the center, children bring their own lunch or lunch is purchased by an outside source. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas are in safe condition. There is a blacktop cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The Director stated no weapons are stored on site and none were observed.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

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,
, CA

FACILITY NAME: NORTH HILLS CHRISTIAN SCHOOL	FACILITY NUMBER: 480101919
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/29/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/05/2019 Section Cited CCR 101226(6)	1 2 3 4 5 6 7	Health-Related Services. When no longer needed by the child, or when the child withdraws from the center, all medications shall be returned to the child's authorized representative or disposed of after an attempt to reach the authorized representative. This requirement is not met as evidenced by: Based on LPA's	1 2 3 4 5 6 7	The Director stated she will return the medication to C1 & C4's authorized representatives and she will obtain current Epipens for C1 & C4. The Director will produce and submit that details a plan that
	8 9 10 11 12 13 14	observation at 11:45am. LPA observed auto injector Epipen expired 02/2019 and C4's Epipen expired 12/2018. This poses a potential health and safety risk to C1 & C4.	8 9 10 11 12 13 14	will remind staff to check IMS medication and the plan will outline the center's plan to informed parents about IMS medication that are due to expire a month in advance. Director will submit plan to LPA by 06/05/19.
	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: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

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,
, CA

FACILITY NAME: NORTH HILLS CHRISTIAN SCHOOL	FACILITY NUMBER: 480101919
	VISIT DATE: 05/29/2019

NARRATIVE

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During today's inspection, staffing ratios were being met and 78 children were being supervised by 6 teachers and 4 aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications. Nine staff records were reviewed at 10:19am, and contained documentation of education and training, as required. Eight children’s records were reviewed at 11:14am, and contained identification forms with authorized representative information. This facility is providing Incidental Medical Services (IMS). The Department’s Incidental Medical Services (IMS) policy was discussed with the Director. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. At 11:45am, LPA observed C1's auto injector Epipen expired 02/2019 and C4's Epipen expired 12/2018. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

LIC809 (FAS) - (06/04)

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