483008714-2-9-2022-01-CC-MAUN-CBGVRE-20220209153949

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483008714
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:40:03 PM

Document Has Been Signed on 02/09/2022 03:40 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:	LITTLE ANGELS PRESCHOOL		FACILITY NUMBER:	483008714
ADMINISTRATOR:	LINDA MARGARET REID		FACILITY TYPE:	850
ADDRESS:	1350 AMADOR STREET		TELEPHONE:	(707) 652-5642
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY:	12	CENSUS: 2	DATE:	02/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Linda Margaret Reid		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 did not have any standing waiver(s). The facility’s operating hours are 8:30am - 5:00pm, 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 large classroom cabinet. 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. The facility provides paper cups for children to retrieve only cold water from a water-cooling system with a filtration system. The children’s bathroom is in safe and sanitary condition, and contained two toilets and two sinks. 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), Earthquake Preparedness Checklist, Personal Rights, Parents’ Rights (PUB 394), California Child Passenger Safety Law, and Local county public health contact information, were posted in a prominent area near the facility entrance. 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 equipment and surface areas were in safe condition. (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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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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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: LITTLE ANGELS PRESCHOOL	FACILITY NUMBER: 483008714
	VISIT DATE: 02/09/2022

NARRATIVE

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There is wood chip cushioning underneath climbing structures to absorb falls, however; underneath the children’s swings did not contain cushion material to absorb the children’s fall. LPA issued a Technical Violation for this deficiency. 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 Licensee did not furnish facility roster of the children currently in care. During today's inspection, staffing ratios were being met, and 3 children were being supervised by Licensee/Center Director.

The facility was operating within the licensed capacity. The Licensee/Center Director did not furnish a current EMSA approved Pediatric CPR and First Aid certification. The sign-in/sign-out procedure contained time sign in/out and children’s authorized representative’s full signature and was in compliance. Licensee/Center Director did not furnish her current AB 1207 Mandated Reporter Training certificate. Three (C1-C3) children’s records were reviewed at 11:41am and records reviewed revealed C1 was missing Physician’s Report (LIC 701) and Immunization Record (IR) was not transcribed onto blue CDPH 286, while C2 &-C3 were missing a signed Admission Agreement, LIC 701, IR, and IR were not transcribed onto the blue CDPH 286. The facility conducted an emergency disaster drill within last six months and the last drill was conducted on 02/09/22.

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. Exit interview conducted and report was reviewed with the Licensee, Linda Reid.

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. 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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/09/2022 03:40 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: LITTLE ANGELS PRESCHOOL	FACILITY NUMBER: 483008714
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 LPA's interview with Licensee/Center Director and Licensee/Center Director not furnishing her current AB 1207 Mandated Reporter Training certificate. 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: 03/26/2022
	Plan of Correction
1 2 3 4	Licensee/Center Director stated she would ensure that all staff completed the online AB 1207 Mandated Reporter Training module at, mandatedreporterca.com, and Licensee would submit a her current certificate to the Department by 03/26/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

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 LPA's interview with Licensee/Center Director and Licensee not furnishing her current EMSA approved Pediatric CPR/First Aid certification. 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: 02/23/2022
	Plan of Correction
1 2 3 4	Licensee/Center Director stated she would obtain and submit her current EMSA approved Pediatric CPR and First Aid certification to the Department by 02/23/2022 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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/09/2022 03:40 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: LITTLE ANGELS PRESCHOOL	FACILITY NUMBER: 483008714
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on three children's (C1-C3) records reviewed at 11:41am which revealed C1-C3's records did not contain completed Physician's Report (LIC 701). 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: 02/23/2022
	Plan of Correction
1 2 3 4	Licensee/Center Director stated she would provide C1-C3's parents with a copy of LIC 701 for parents to provide to the children's medical doctors and Licensee would obtain the completed forms and submit complete LIC 701 for C1-C3 to the Department by 02/23/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Type B

Section Cited

CCR

101220.1(a)

Immunizations

(a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on three children's (C1-C3) records reviewed at 11:41am which revealed C2 & C3's records did not contain evidence of immunization prior to admission in care and C1-C3's immunization records were not transcribed on CDPH 286. 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: 02/23/2022
	Plan of Correction
1 2 3 4	Licensee/Center Director stated she would obtain evidence of C2-C3's immunization, and she would also transcribe C1-C3's immunization onto blue CDPH 286 and submit evidence of immunization and transcribed forms to the Department by 02/23/22 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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/09/2022 03:40 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: LITTLE ANGELS PRESCHOOL	FACILITY NUMBER: 483008714
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.841

Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's interview with Licensee/Center Director which revealed the Licensee did not have a facility roster of the children in care available for review. 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: 02/23/2022
	Plan of Correction
1 2 3 4	Licensee/Center Director stated she would complete a Facility Roster of the children in care and she would submit a copy of the current roster to the Department by 02/23/22 via mail, email or fax. Email: melchisedeck.augustin@ds.ca.gov & Fax: 707-588-5099

Type B

Section Cited

CCR

101221(b)(4)

(b) Each record shall contain information including, but not limited to, the following: (4) Date of Admission. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on three children's (C1-C3) records reviewed at 11:41am which revealed C1-C3's records were missing Admission Agreements with children's authorized representatives' signatures. 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: 02/23/2022
	Plan of Correction
1 2 3 4	Licensee/Center Director stated she would obtain evidence of C1-C3's Admission Agreement with the children's authorized representatives' full signature and Licensee would submit evidence of the children's signed agreements to the Department by 02/23/22 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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC809 (FAS) - (06/04)

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