490100475-9-8-2023-01-CC-YYAG-CVGS7M-20230908133745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490100475
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:37:55 PM

Document Has Been Signed on 09/08/2023 01:37 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:	CROSS & CROWN LUTHERAN PRESCHOOL		FACILITY NUMBER:	490100475
ADMINISTRATOR:	MC CARTHY, MANDY		FACILITY TYPE:	850
ADDRESS:	5474 SNYDER LANE		TELEPHONE:	(707) 795-7863
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	70	CENSUS: 15	DATE:	09/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Mandy McCarthy, Center Director		TIME COMPLETED:	01:56 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	An annual required inspection was made to the facility by Licensing Program Analysts (LPA), Y. Yang C. Castro. The facility file was reviewed prior to this inspection. A review of the personnel report on 09/08/23 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility representative 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 LPAs met with the facility's center director, Mandy McCarthy today. The facility’s operating hours are 07:30am-05:00pm, Monday – Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The toys, floors, desks and other equipment and surfaces were clean, free of toxins, safe and in good condition. The facility was free of flies, insects and rodents. There is drinking water available to children both indoors in the classrooms and outdoors on the playground. The children’s bathrooms were in sanitary condition. Food prep areas are clean. Food is properly stored and free of contamination. Children bring meals and snacks from home. Garbage cans containing solid waste were in good repair and had tight fitting lids. The facility's play yards are fully fenced and free of hazards. There is wood chip cushioning on the playground. There were no bodies of water observed. The facility representative stated no weapons or poisons are stored on site. There is at least one smoke and carbon monoxide detector on site. During today's inspection the facility was operating within the licensed capacity. At least one staff member present during the visit possessed current CPR and First Aid certifications. The sign in/out procedure was reviewed and was in compliance with regulations. Ten children's records were reviewed and contained identification forms with authorized representative information, as well as medical assessment forms. Three staff files were reviewed and contained the required documents as specified on the inspection checklist. Continued on LIC 809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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: CROSS & CROWN LUTHERAN PRESCHOOL	FACILITY NUMBER: 490100475
	VISIT DATE: 09/08/2023

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/.

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

The facility representative 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the center director, Mandy McCarthy. There were no Title 22 deficiencies cited during today's inspection.

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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