490109162-12-8-2022-01-CC-KOCL-CLWR25-20221208113746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490109162
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:37:57 AM

Document Has Been Signed on 12/08/2022 11:37 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:	OLD ADOBE SCHOOL		FACILITY NUMBER:	490109162
ADMINISTRATOR:	MURRAY, MICHAELA		FACILITY TYPE:	850
ADDRESS:	252 WEST SPAIN STREET		TELEPHONE:	(707) 408-2383
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	45	CENSUS: 18	DATE:	12/08/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Michaela Murray, Director		TIME COMPLETED:	11:55 AM

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 12/08/22 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 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’s operating hours are 07:30am- 5:30pm, 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. The Director states that there are no poisons at the child care center but can combination lock them in a outdoor shed. 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 their lunch, snacks are provided and 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 is 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 Director stated that there are no bodies of water and none were observed. The Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met as there were 18 children being supervised by 5 staff in two classrooms. 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: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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 2

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: OLD ADOBE SCHOOL	FACILITY NUMBER: 490109162
	VISIT DATE: 12/08/2022

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

At least one staff member present during the visit possessed current Pediatric CPR and First Aid certifications. Ten children’s records were reviewed at 10:15am, and contained identification forms with authorized representative information, as well as medical assessments. Five staff records were reviewed at 10:45 am.
Incidental Medical Services (IMS) policy was discussed. This facility is not providing IMS 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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Michaela Murray. No title 22 regulations were cited at today's visit.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2