<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008621
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:33:38 PM

Document Has Been Signed on 12/05/2024 04:33 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BENICIA USD - MATTHEW TURNER PRESCHOOLFACILITY NUMBER:
483008621
ADMINISTRATOR/
DIRECTOR:
REGIS, JUNEFACILITY TYPE:
850
ADDRESS:540 ROSE DRIVETELEPHONE:
(707) 747-8367
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 23DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:23 AM
MET WITH:Robin MulhollandTIME VISIT/
INSPECTION COMPLETED:
04:45 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
Licensing Program Analyst (LPA) Selena Mariani made an unannounced case management visit and met with Site Supervisor (SS) Maribel Romero and Lead Teacher Robin Mulholland to investigate the circumstances of the self reported unusual incident which involve Child 1 (C1) falling from a play structure and sustaining an injury on 11/12/24. On 11/15/24 the facility submitted an incomplete Unusual Incident Report (UIR) but on 11/19/24 submitted a competed UIR. During today's inspection, LPA met with Lead Teacher Robin Mulholland. During today's inspection, LPA conducted interviews with 4 Staff, Child 1 (C1) and made observations in the facility.

Interviews with S1 revealed that on 11/12/24, C1 went down the monkey bars, fell and sustained an injury to the right arm. Preschool staff members reported they did not observe the incident however multiple parties including C1 notified staff of the incident. S1 explained they were close enough to hear a thud from C1’s fall which prompted them to proceed to C1. Prior to the incident, there were two teachers supervising the children on the playground. Interviews revealed an approved aide was near C1, but is not part of the staff responsible for supervising the children. Interviews revealed that S1 was near C1 but was watching the kids on the black top area. Interviews also revealed the staff responsible for supervising the children was not standing, walking the perimeter, constantly scanning the playground; and as a result, the staff did not have a wide peripheral view of the children. LPA has determined that this unusual incident occurred as a lack of supervision. The Lead Teacher Robin said with the SS they develop and review a supervision plan with the facility staff, to prevent this unusual incident from reoccurring. LPA discussed Regulation 101229(a)(1). This report was reviewed and discussed with the Lead Teacher Robin. Notice of Site Visit shall be posted for 30 days from today's date. The following violation of the California Code of Regulations, Title 22; Division 12, were observed. See LIC 809D. Appeal Rights were provided.

LPA Selena Mariani informed Lead Teacher Robin that this report dated 12/05/2024 document(s) one Type A citation(s) 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. Also, LPA Selena Mariani informed the Lead Teacher Robin to provide a copy of this licensing report dated 12/05/2024 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.

Leslie LeporiTELEPHONE: (707) 588-5060
Selena MarianiTELEPHONE: (916) 605-8974
DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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 2
Document Has Been Signed on 12/05/2024 04:33 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: BENICIA USD - MATTHEW TURNER PRESCHOOL

FACILITY NUMBER: 483008621

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 12/05/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections
Deficient Practice Statement
1
2
3
4
POC Due Date: 12/05/2024
Plan of Correction
1
2
3
4
The Lead Teacher Robin said she and SS will discuss zoning supervision, make sure all staff acknowledge regulation 101229(a)(1) and understand the supervision requirements by 12/6/24. Lead Teacher & SS will conduct active supervision training with all staff submit training overview & attendance to LPA Selena by 12/20/24 via email, mail or fax.
Email: selena.mariani@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.
Leslie LeporiTELEPHONE: (707) 588-5060
Selena MarianiTELEPHONE: (916) 605-8974

DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024

LIC809 (FAS) - (06/04)
Page: 2 of 2