490100827-4-6-2022-01-CC-KOCL-CD8S27-20220406132904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490100827
Report Date: 04/06/2022
Date Signed: 04/06/2022 01:29:12 PM

Document Has Been Signed on 04/06/2022 01:29 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:	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: 16	DATE:	04/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Jennifer Wooden, Asst. Director		TIME COMPLETED:	01:45 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	An annual required inspection was made to the facility by Licensing Program Analyst (LPA), Kevin O'Connell. The facility file was reviewed prior to this inspection. A review of the personnel report on 04/06/22 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 Assistant Director 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’s operating hours are 08:30am- 1:00pm, Monday – Friday and a aftercare program from 1:00 to 3:30pm. 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 key locked in an upper cabinet in the "off limits" kitchen/ office. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is drinking water available to children both indoors and outdoors on the playground. The children’s bathrooms were in safe and sanitary condition. Children bring all of their own food which consists of a lunch and a snack, no menus were posted. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There are wood chips and sand underneath climbing structures and/or play equipment to absorb falls. The LPA observed a working carbon monoxide detector and a charged fire extinguisher of at least 2A 10: BC or larger. The Assistant Director stated that there are no bodies of water and none were observed. The Assistant Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met as there were 16 children being supervised by three teachers. The facility was operating within the licensed capacity. Sign in, sign out regulation was reviewed, discussed and in compliance.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

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: VALLEY OF THE MOON NURSERY SCHOOL	FACILITY NUMBER: 490100827
	VISIT DATE: 04/06/2022

NARRATIVE

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At least one staff member present during the visit possessed current Pediatric CPR and First Aid certifications. Ten children’s records were reviewed at 11:15am, and contained identification forms with authorized representative information, as well as medical assessments. Three staff records were reviewed at 12:05 pm.

Incidental Medical Services (IMS) policy was discussed. No IMS is being offered at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

There were no Title 22 violations cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Assistant Director, Jennifer Wooden,

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:

www.cdss.ca.gov/inforesources/communty-care-licensing/process.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC809 (FAS) - (06/04)

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