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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008714
Report Date: 07/13/2022
Date Signed: 07/13/2022 11:45:57 AM


Document Has Been Signed on 07/13/2022 11:45 AM - 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 PRESCHOOLFACILITY NUMBER:
483008714
ADMINISTRATOR:LINDA MARGARET REIDFACILITY TYPE:
850
ADDRESS:1350 AMADOR STREETTELEPHONE:
(707) 652-5642
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:12CENSUS: 8DATE:
07/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Clara Rutledge - Lead TeacherTIME COMPLETED:
10:30 AM
NARRATIVE
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During the course of a complaint investigation, Licensing Program Analyst (LPA), Melchisedeck Augustin conducted a Case Management visit to cite a violation of Health and Safety Code (HSC), 1596.866(a)(1). Upon LPA's arrival to the facility, LPA met with Lead Teacher, Clara Rutledge (LT) who was the only staff present and was providing care and supervision for three children for the first half hour of LPA's visit. LT provided a copy of her current Emergency Medical Services Authority (EMSA) approved Pediatric CPR/First Aid certification, however; LT stated she had not completed 8 hours of health and safety training and did not furnish a copy of her Preventive Health and Safety certificate to LPA. LPA reviewed one staff (LT) at 9:45am which confirmed that the record did not contain Preventive Health and Safety certificate or a current AB 1207 Mandated Reporter Training certificate. The Licensee (LS) arrived at the facility after half hour and at which time, LS stated she also did not have a current AB 1207 Mandated Reporter Training certificate, and on 02/09/22, the facility was cited a deficiency for not complying with Health and Safety, 1596.8662(b)(1).

LPA consulted with LS and LT, and both parties stated they understood and appeared to have acknowledged Health and Safety Codes. Exit interview conducted, and report was reviewed with the Licensee. 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 Health and Safety Code, Title 22, Division 6, Chapter 3.4, Article 02 of the California Day Care Act violations are being cited on the attached LIC 809D. Appeal Rights were provided.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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 07/13/2022 11:45 AM - 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: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2022
Section Cited

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In addition to other required training, at least one director or teacher at each day care center, and each family day care home licensee who provides care, shall have at least 15 hours of health and safety training, and if applicable, at least one additional hour of training pursuant to clause (ii) of subparagraph (C) of
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paragraph (2).

This requirement is not met as evidenced by: Based on LPA's observations and staff statement and staff record reviewed which confirmed the staff did not have Preventive Health and Safety certificate. This poses/posed a potential health, safety and/or personal rights risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Type B
08/27/2022
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child 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
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following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by: Based on staff record reviewed & LS's statement which confirmed staff did not have a current AB 1207 Mandated Reporter Training certificate, and this poses a potential health, safety and/or personal rights risk to the children in care.
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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 LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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