490100827-5-6-2019-01-CC-KOCL-BBWRN9-20190506130957

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490100827
Report Date: 05/06/2019
Date Signed: 05/06/2019 01:10:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	VALLEY OF THE MOON NURSERY SCHOOL		FACILITY NUMBER:	490100827
ADMINISTRATOR:	GALLAGHER, AMY		FACILITY TYPE:	850
ADDRESS:	136 MISSION TERRACE		TELEPHONE:	(707) 938-4265
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	30	CENSUS: 23	DATE:	05/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Renise Chiotti, Assistant Director		TIME COMPLETED:	01:20 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 annual inspection was made to the facility by Licensing Program Analyst (LPA) Kevin O'Connell and Leslie Lepori. The facility file was reviewed prior to this visit. A review of the personnel report on 5/06/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This facility operates from M-F 8:30AM -1:00PM, and 1:00pm to 3:00pm as an after care program. This Preschool is licensed for 30 children. During today's inspection three staff were supervising 23 children, staffing ratios were being met and the facility was operating within the licensed capacity. The facility was toured inside and outside at 11:00 am 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. The Assistant Director states that there are no poisons on the premises. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children's bathrooms are in safe and sanitary condition. Children bring their own lunches, snacks are provided and menus were posted. Garbage containers containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector and a charged fire extinguisher of at least 2A 10: BC or larger. The playground was completely fenced and the equipment and surface areas appeared in safe condition. The playground was free of hazards. There is sand for cushioning underneath climbing structures and/or play equipment to absorb falls. The Assistant Director stated that no weapons are stored on site and that there are no bodies of water and none were observed. At least one staff who opens and closes had current Pediatric First Aid and CPR certifications. Four staff records were reviewed at 11:35am and contained documentation of education and training and Mandated Reporter Certificates. Immunizations were also reviewed. Staff immunizations for Pertussis and Measles & Influenza were all current.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: VALLEY OF THE MOON NURSERY SCHOOL	FACILITY NUMBER: 490100827
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/13/2019 Section Cited CCR 101229.1(a)	1 2 3 4 5 6 7	101229.1(a) 1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.	1 2 3 4 5 6 7	The Assistant Director agreed to develop a plan to insure that each child is signed in and out each day and will show proof of staff training and send to CCL by 5/13/19. kevin.oconnell@dss.ca.gov
	8 9 10 11 12 13 14	This requirement has not been met as evidenced by: LPA observed that four or more children were not signed out from 4/29/19 to 5/6/19 while reviewing the electronic sign in/ sign out program. The assistant Director acknowledged that there were not any other forms at the facility showing that the children were signed out. This is a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: VALLEY OF THE MOON NURSERY SCHOOL	FACILITY NUMBER: 490100827
	VISIT DATE: 05/06/2019

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
26
27
28
29
30
31
32

The sign-in/sign-out procedure was reviewed at 11:52am with the Assistant Director and was not in compliance. Ten children’s records were reviewed at 11:25am and contained signed admission agreements.
Incidental Medical Services (IMS) policy was discussed. IMS is not being provided at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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: http://www.ada.gov/childqanda.htm

This report, as well as the AAP Guide to Safe Sleep, Safe Sleep in Childcare brochure, What does a Safe Sleep Environment Look Like brochure & Safe Sleep Concepts handout, were reviewed and discussed with the Licensee. The Effects of Lead Exposure brochure has been reviewed with and discussed with the Licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

Failure to keep this notice posted for 30 days may result in a civil penalty of $100. The Assistant Director was provided a copy of Licensee's rights (LIC 9058 12/15).The following violations of the California Code of Regulations, Title 22; Division 12, were observed:
see LIC 809D.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3