483007899-1-28-2022-01-CC-MAUN-CB4VQR-20220128153846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483007899
Report Date: 01/28/2022
Date Signed: 01/28/2022 03:39:06 PM

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:	NEW HORIZONS A MONTESSORI SCHOOL		FACILITY NUMBER:	483007899
ADMINISTRATOR:	ANICETE, MARILYN		FACILITY TYPE:	850
ADDRESS:	900 FAIRGROUNDS DRIVE		TELEPHONE:	(707) 644-5066
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	45	CENSUS: 36	DATE:	01/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Marilyn Anicete- Licensee/Center Director		TIME COMPLETED:	04:00 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. 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. Licensee 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 6:30am - 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 in a cabinet in the office. 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. Children bring their own cups from home, as well as the facility provides children with cups to retrieve water from a water fountain with a filtration system. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. A Menu was posted in an area accessible for review by the child's authorized representative. The Daily Activities schedule, the Emergency Disaster Plan (LIC 610), and Parents’ Rights (PUB 393) were not posted. Garbage cans containing solid waste have tight fitting lids. LPA observed a working carbon monoxide and smoke detectors, and a fire extinguisher rated at least 2A10BC. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is foam cushioning underneath climbing structures and/or play equipment to absorb falls. There is an awning for shade area. There were no bodies of water observed. The Licensee/Center Director stated no weapons are stored on site and none were observed. The facility roster was reviewed and appeared to be complete. During today's inspection, staffing ratios were being met, and 36 children were being supervised by four teachers and one aide. (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: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

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 7

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: NEW HORIZONS A MONTESSORI SCHOOL	FACILITY NUMBER: 483007899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(a)

Disaster and Mass Casualty Plan

(a) Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation of the LIC 610, Personal Rights, Earthquake Preparedness checklist, Daily Activities Schedule were not posted. 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: 02/07/2022
	Plan of Correction
1 2 3 4	Licensee stated she would submit evidence of the required positing posted on the parent board near near the facility entrance. The Licensee would submit a photograph of the forms posted by 02/07/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Type B

Section Cited

CCR

101218.1(c)

Admission Procedures and Parental and Authorized Representative's Rights

(c) The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation of the Parents’ Rights (PUB 393) not posted. 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: 02/07/2022
	Plan of Correction
1 2 3 4	Licensee stated she would submit evidence of the parents' rights posted on the parent board near near the facility entrance. The Licensee would submit a photograph of the forms posted by 02/07/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

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	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

LIC809 (FAS) - (06/04)

Page: 2 of 7

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: NEW HORIZONS A MONTESSORI SCHOOL	FACILITY NUMBER: 483007899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2022

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
1 2 3 4	Based on staff records reviewed at 10:08am which revealed that CD was missing proof of immunity agains the Measles, S3 was missing proof of immunity against Measles and Pertussis, and S1-S4 were missing 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: 02/18/2022
	Plan of Correction
1 2 3 4	Licensee stated she would talk with the staff and staff would obtain their required immunization records and the Licensee would submit a copy of any immunization records that was missing for CD, S1-S4. The Licensee would submit evidence by 02/18/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on staff records reviewed at 10:08am which revealed CD and S1-S4's records did not contain current AB 1207 Mandated Reporter Training certificates. 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: 03/14/2022
	Plan of Correction
1 2 3 4	Licensee/CD stated she and S1-S4 would complete the online AB 1207 Mandated Reporter Training module at, mandatedreporterca.com. The Licensee would submit a copy of staff's current certificates to the Department by 03/14/22. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

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	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

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: NEW HORIZONS A MONTESSORI SCHOOL	FACILITY NUMBER: 483007899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on staff records reviewed at 10:08am which revealed that S2 was the only staff that possessed a current Pediatric CPR/First Aid certification, however; S2 was not present when LPA arrival to the facility. 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: 02/07/2022
	Plan of Correction
1 2 3 4	Licensee stated she already completed an EMSA approved Pediatric CPR/First Aid training and she would locate and submit her current certificate to the Department by 02/07/22 via mail, email or fax Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

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
1 2 3 4	Based on staff record reviewed at 10:08am which revealed S3's record did not contain completed Health Screening (LIC 503) and evidence of negative TB clearance. 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: 02/18/2022
	Plan of Correction
1 2 3 4	Licensee stated she would ensure that S3 obtain a completed LIC 503 and evidence of negative TB clearance, and the Licensee would submit copy of the completed LIC 503 and evidence of engative TB clearance to the Department by 02/18/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

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	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: NEW HORIZONS A MONTESSORI SCHOOL	FACILITY NUMBER: 483007899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(a)(1)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's review of the children's sign in/out procedure which revealed that several children's were not signed 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: 02/07/2022
	Plan of Correction
1 2 3 4	The Licensee stated she would post a written note on the front door to remind the parents to sign their child(ren) in and out each day. Licensee stated she would also review the children's sign in/out procedure in the morning to ensure the binders were complete. Licensee stated she would submit a written statement detailing how she intends to comply with CCR 101229.1(a)(1), as well as submit pictures of the corrected items.

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: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

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: NEW HORIZONS A MONTESSORI SCHOOL	FACILITY NUMBER: 483007899
	VISIT DATE: 01/28/2022

NARRATIVE

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The facility was operating within the licensed capacity. S2 was the only staff that possessed a current Pediatric CPR and First Aid certification, however; S2 was not present upon LPA’s arrival. The sign-in/sign-out procedure was reviewed and was not in compliance. The sign in/out procedure contained time signed in and parents’ signatures but did not contain time singed out. Five staff (CD, & S1-S4) records were reviewed at 10:08am and staff records reviewed revealed CD and S1-S4 did not have current AB 1207 Mandated Reporter Training certificates and proof of immunity against the Influenza, S3 was missing Health Screening (LIC 503) and evidence of negative TB clearance and proof of immunity against the Measles, and Pertussis. Ten (C1-C10) children’s records were reviewed at 11:13am and contained signed admission agreements. The facility conducted an emergency disaster drill within last six months and the last drill was conducted on 01/28/22.

This facility is providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Licensee/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 licensee, Marilyn Anicete. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

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: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

LIC809 (FAS) - (06/04)

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