483007757-12-1-2022-01-CC-EHTS-CLQ39X-20221201170352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483007757
Report Date: 12/01/2022
Date Signed: 12/01/2022 05:04:01 PM

Document Has Been Signed on 12/01/2022 05:04 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:	CIRCLE OF FRIENDS CHILD DEVELOPMENT CENTER - P/S		FACILITY NUMBER:	483007757
ADMINISTRATOR:	THOMAS, ROSELLA E.		FACILITY TYPE:	850
ADDRESS:	3330 DOVER AVENUE		TELEPHONE:	(707) 425-2717
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY: 88	TOTAL ENROLLED CHILDREN: 48	CENSUS: 35	DATE:	12/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:26 AM
MET WITH:	Center Director Danielle		TIME COMPLETED:	05:10 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 inspection was made to the facility by Licensing Program Analyst (LPA), Elpidia Hernandez Torres. The facility file was reviewed prior to this inspection. A review of the personnel report on 12/01/2022 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 operated in part by Head Start and private entity The facility’s operating hours are 07:00AM- 06:00PM, 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. The regulation that poisons are locked with a key or combination lock was reviewed. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors through the use of water pitchers and outdoors through water fountains on the preschool side, and water pitchers on the toddler side. The children’s bathrooms were in safe and sanitary condition. A current menu was posted. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is foam in ground cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The center director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were 35 children were being supervised by 8 teachers/aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (D1) possessed current CPR and First Aid certifications. 10 children’s records were reviewed at 12:04PM, and contained identification forms with authorized representative information, as well as medical assessments. Continued on 809-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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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Document Has Been Signed on 12/01/2022 05:04 PM - It Cannot Be Edited

Created By: Elpidia Hernandez Torres On 12/01/2022 at 04:09 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: CIRCLE OF FRIENDS CHILD DEVELOPMENT CENTER - P/S	FACILITY NUMBER: 483007757
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review,Center was not able to produce a disaster drill log with a date, time, type of drill, or how many children were in attendance. The Center did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2022
	Plan of Correction
1 2 3 4	Center Director agreed to conduct a drill by 12/22/2022 and email, mail or fax a picture of Log to LPA Hernandez Torres. Email: Elpidia. Hernandez-Torres@dss.ca.gov, Mail: 1450 Neotomas Ave Suite 100 Santa Rosa Ca 95405, Fax: 707-599-5099

Type B

Section Cited

CCR

101221(b)(6)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review Facility transitioned to electronic record keeping and could not produce copy of admissions agreement. The center did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2022
	Plan of Correction
1 2 3 4	Center director agreed to provide a signed document with all ten guaridans signing they have recieved their copy of admissions agrement with the date they recieved it to LPA Hernandez Torres by 12/22/2022 via email, mail or fax. Email: elpidia.hernandez-torres@dss.ca.gov, mail: 1450 Neotomas Ave suite 100 Santa Rosa CA 95405, fax: 707-599-5099.

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

LICENSING EVALUATOR NAME:

Elpidia Hernandez Torres

LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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

FACILITY NAME: CIRCLE OF FRIENDS CHILD DEVELOPMENT CENTER - P/S	FACILITY NUMBER: 483007757
	VISIT DATE: 12/01/2022

NARRATIVE

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All 10 children had immunization records but only 2 had them transcribed on blue CDPH 286 an advisory note was issued. All children were missing their admissions agreement a deficiency was issued. Nine staff records were reviewed at 02:06PM. The center recently transitioned to electronic filing, all staff were missing one or more required documents to be placed in their files, an advisory note was issued. The sign in/out procedure was reviewed and in compliance. Center was not able to produce verification of last disaster drill a deficiency was issued.

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.

LPA discussed the safe sleep regulations with center director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed center director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: http://www.ada.gov/childqanda.htm

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Center Director Danielle Haynes

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.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC809 (FAS) - (06/04)

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