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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483007757
Report Date: 05/30/2024
Date Signed: 05/30/2024 06:43:10 PM

Document Has Been Signed on 05/30/2024 06:43 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:CIRCLE OF FRIENDS CHILD DEVELOPMENT CENTER - P/SFACILITY NUMBER:
483007757
ADMINISTRATOR/
DIRECTOR:		THOMAS, ROSELLA E.FACILITY TYPE:
850
ADDRESS:3330 DOVER AVENUETELEPHONE:
(707) 425-2717
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 88TOTAL ENROLLED CHILDREN: 34CENSUS: 29DATE:
05/30/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Center Director TIME VISIT/
INSPECTION COMPLETED:
06:55 PM
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An inspection was made to the facility by Licensing Program Analysts (LPAs), Melchisedeck Augustin and Elpidia Hernandez Torres. The facility file was reviewed prior to this inspection. A review of the personnel report on 05/30/2024 indicates that not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. According to S1's statement, she had been working at the facility since 05/06/2024 and she had not obtained a criminal record clearance, and Department records further confirmed S1 had not obtained an approved criminal record clearance. An immediate civil penalty in the amount of $500 is being issued because the Licensee did not ensure S1 obtained a criminal record clearance prior to working at the facility. This program is operated in part by Head Start and private entity. Center Director 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 07:00AM- 05:30PM, 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. Center director reported poisons are not stored on the premises. The facility has pest control come out once a month to help with the Gnats. 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 that are filled from kitchen sink water filter and outdoors through the use of water fountains. The children’s bathrooms were in safe and sanitary condition. A current menu was posted in the hallway on the parent board. Food prep areas are clean. Food is properly stored and free of contamination. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 05/30/2024
NARRATIVE
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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 pour in play 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 29 children were being supervised by seven teachers/aides.

LPAs observed three children over the age of 36 months (C1, C2, and C4) in the toddler component classroom, deficiency was issued. At least one staff member present during the visit Center director possessed current CPR and First Aid certification. Seven children’s records were reviewed at 11:48AM, and contained identification forms with authorized representative information, as well as medical assessments. All seven children were missing admissions agreements, deficiency was issued. Nine staff records were reviewed at 12:52PM, and several were missing TB testing, and LIC 503 health screening reports deficiency was issued. Staff were also missing immunization deficiency was issued. All staff were missing LIC 501 Personnel Record, deficiency was issued. Several guardians had not signed children in and/ or out on more than five occasions, deficiency was issued.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
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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: 05/30/2024
NARRATIVE
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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 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/.

Center Director 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.

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.

LPA Hernandez Torres informed center director to provide a copy of this licensing report dated 05/30/2024 that documents any Type A citation(s) 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.

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 center director. LPA Hernandez Torres informed center director that this report dated 05/30/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Appeal rights were provided.

Exit interview conducted and report was reviewed with the center director Danielle Haynes.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
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Document Has Been Signed on 05/30/2024 06:43 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 05/30/2024 at 04:58 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: 05/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review,staff ( S1,S2, S3, S4,S5, S7, S8) were missing proof of immunity or vacination against measles and/or pertusis, and/or influenza 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: 06/30/2024
Plan of Correction
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Center Director reported she would be in communication with staff and email, mail or fax missing items to LPA Hernandez Torres on or before 06/30/2024.
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 record review, staff ( S1, S2, S5, S12) were missing evidence of negative TB results. During record review S1 and S12 were missing LIC 503 health screening report. 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: 06/30/2024
Plan of Correction
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Center Director reported she would be in communication with staff and email, mail or fax missing items to LPA Hernandez Torres on or before 06/30/2024
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: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/30/2024 06:43 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 05/30/2024 at 04:58 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: 05/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed all staff were missing LIC 501 the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2024
Plan of Correction
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Center Director reported she would be in communication with staff and email, mail or fax missing items to LPA Hernandez Torres on or before 06/30/2024.
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
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Based on records reviewed all children's files were missing a copy of admission agreement., 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: 06/20/2024
Plan of Correction
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LPA printed out a copy of the admission agreement regulation. LPA reccomended center director review the current admission agreeement and to the regulaiton and add the items it is missing. Center Director agreed to email, fax or mail a copy of the updated admissions agreeement to LPA Hernandez Torres on or before 06/20/2024
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: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 05/30/2024 06:43 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 05/30/2024 at 04:58 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: 05/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed there were more than five instances where guardians were not signing children in and/or out. 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: 06/13/2024
Plan of Correction
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Center Director reported she will send out a letter to guardians reminding them to sign their children in and out daily. Center dirctor agreed to email LPA Hernandez Torres a copy of news letter that will be sent out to guardians.
Type B
Section Cited
CCR
101161(a)
Limitations on Capacity and Ambulatory Status
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the center has a toddler component (18 months-36 months) in the "Explorers" classroom, LPAs observed at least three children (C1, C2, and C4) over 36 months old co-mingling in the toddler classroom.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: 06/30/2024
Plan of Correction
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Center director reported, the center will meet with the child start representative and come up with a plan on how to ensure all children in that classroom are under 36 months. LPA will make a follow up visit at a later time to verify all children enrolled in the classroom are under 36 months.
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: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 05/30/2024 06:43 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 05/30/2024 at 04:59 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: 05/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(1)
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
(1)Obtain a California clearance or a criminal record exemption as required by the Department

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview with S1 and Department records which confirmed S1 had not obtained a criminal record clearance and $500 civil penalty was assessed. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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LPA provided Director with LIC 9163 to provide to S1 to get finger printed and Director agreed S1 would not work on the premises until an approved criminal record clerance was obtained. Director intends to submit a copy of the completed LIC 9163 to the Department by 05/31/24.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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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
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024


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