480101919-4-25-2022-01-CC-MAUN-CDTVT9-20220425164245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480101919
Report Date: 04/25/2022
Date Signed: 04/25/2022 04:43:02 PM

Document Has Been Signed on 04/25/2022 04:43 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

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: 56	DATE:	04/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:56 AM
MET WITH:	Ludeza Parinas		TIME COMPLETED:	05:00 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	A Required-1 Year inspection was made to the facility by Licensing Program Analyst (LPA), M. Augustin. The facility file was reviewed prior to this visit. This program is not a Title 5 funded program. The facility has a waiver that allows children to be electronically signed in/out. 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. Center 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. The facility’s operating hours are 6:00am - 6:00pm, Monday-Friday. 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. Poisons are locked up in the Maintenance Department. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is drinking water available to children both indoors and outdoors. There are drinking fountains inside each classroom and on the playground, as well as the facility provided bottles of water to the children during outdoor activities. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. AM/PM snack is provided by the center, children bring their own lunch or lunch is purchased by an outside source. Food is properly stored and refrigerated as needed. There was no contaminated food observed. A current menu was posted on parent board in each classroom. The Daily Activities schedule, the Emergency Disaster Plan (LIC 610), and Parents’ Rights (PUB 393) were posted. Garbage cans containing solid waste have tight fitting lids. Each classroom had a working carbon monoxide and smoke detectors, and a fully charged fire extinguisher rated at least 2A10BC. The playground was free of hazards. (Continue to LIC 809-C)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

Document Has Been Signed on 04/25/2022 04:43 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NORTH HILLS CHRISTIAN SCHOOL	FACILITY NUMBER: 480101919
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(B)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's review of storage and prescription label of IMS medications for C11 & C12’s which revealed C11’s IMS medication was expired, as well as the child did not have a current parental consent form (LIC 9221). The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/02/2022
	Plan of Correction
1 2 3 4	Center Director stated she would ask the parent for a current IMS medication for C11 and as well as the LIC 9221 form. The Center Director stated she would submit her evidence of C11's current IMS medication to the Department via mail, email or fax by 05/02/22. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NORTH HILLS CHRISTIAN SCHOOL	FACILITY NUMBER: 480101919
	VISIT DATE: 04/25/2022

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
26
27
28
29
30
31
32

The playground equipment and surface areas were in safe condition. There is a blacktop foam cushioning underneath high climbing structures and/or play equipment to absorb falls. There is a large tree for shade. There were no bodies of water observed. The Center Director stated no firearm(s) or other dangerous weapon(s) are stored on the premise and none were observed during the visit. The facility roster was reviewed and appeared to be complete. During today's inspection, staffing ratios were being met, and 56 children were being supervised by Six teachers and one aide.

The facility was operating within the licensed capacity. CD’s Pediatric CPR/First Aid certification was not EMSA approved and did not meet the Department’s requirements. LPA issued a Technical Violation for this deficiency. The sign-in/sign-out procedure was reviewed and was in compliance. Eight staff (CD, & S1-S7) records were reviewed at 12:57pm and staff records reviewed revealed CD, S1-S7’s records contained completed LIC 9052, current AB 1207 Mandated Reporter Training certificates, required staff immunization, Health Screening (LIC 503) and evidence of negative TB clearance. Ten (C1-C10) children’s records were reviewed at 2:10pm which contained Identification and Emergency Information, Physician’s Report and LIC 995 that were signed by the children’s authorized representatives. The facility conducted an emergency disaster drill within last six months and the last drill was conducted on 04/06/22.

This facility is providing Incidental Medical Services (IMS). LPA reviewed storage and prescription label of IMS medication for C11 & C12 which revealed C11’s IMS medication was expired, as well as the child did not have a current parental consent form (LIC 9221). The Department’s IMS policy was discussed with the Center Director. 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 Licensee/Center Director. All licensing reports are public information and must be made available upon request for at least three years.

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 reviewed with the Center Director, Ludeza Parinas. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided. (Continue to LIC 809-C)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NORTH HILLS CHRISTIAN SCHOOL	FACILITY NUMBER: 480101919
	VISIT DATE: 04/25/2022

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
26
27
28
29
30
31
32

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.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5