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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111008
Report Date: 03/07/2024
Date Signed: 03/07/2024 04:47:21 PM


Document Has Been Signed on 03/07/2024 04:47 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:HEAD START - LINCOLN CENTERFACILITY NUMBER:
490111008
ADMINISTRATOR:CYNTHIA KINGFACILITY TYPE:
850
ADDRESS:604 SIMPSON STREETTELEPHONE:
(707) 546-4984
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:48CENSUS: 13DATE:
03/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Kim RogersTIME COMPLETED:
04:57 PM
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A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Amy Strother in response to two Unusual Incident Reports (UIRs). The first UIR received 02/16/2024 involved supervision ratios. The second UIR received on 02/27/24 involved a lack of supervision. LPA met with Area Supervisor, Kim Rodgers regarding the incidents. According to the incident report dated 02/16/24, on 02/15/24 two fully qualified staff were outside with 15 children when one of the staff brought one child inside to change their wet clothes, leaving the other staff outside with 14 children for 5 minutes, breaking the ratio of one teacher visually observing and supervising no more than 12 children in attendance. According to the incident report dated 02/27/24, on 02/27/24 two fully qualified teachers took the class of children outside, unintentionally leaving 3-year-old child (C1) in the unoccupied classroom without supervision for 20 minutes. The UIR states that at the time of the incident there were 2 to 3 staff located in the office, which is just off of the same room as the classroom, but the office staff were unaware of C1’s presence and were not assigned to supervise C1. C1 was noticed by one of the staff when C1 stood up from behind a shelf in the classroom. The UIR states that C1’s parent was notified of the incident and that staff would be provided with training on transitions. During today’s visit, LPA interviewed two staff (S1 and S2) that were present during the 02/27/24 incident. LPA received and reviewed documentation of a staff training that was conducted at 3:30pm on 02/27/24 with 4 staff (S1-S4) in attendance, covering the topic of active supervision and transitions.

Interviews and documentation corroborate that C1 did not sustain any injuries and did not elope from the facility on 02/27/24, but did lack supervision for 20 minutes. Staff interviewed stated that they have received training on transitions and supervision and are conducting face to name roll calls, head counts and counting the children as the exit or enter the classroom. During today's inspection, staffing ratios were being met, a total of 13 preschool children were being supervised by 3 teachers. The facility was operating within the licensed capacity and ratio requirements.

Continue on LIC809-C

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HEAD START - LINCOLN CENTER
FACILITY NUMBER: 490111008
VISIT DATE: 03/07/2024
NARRATIVE
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Based on available information, it has been determined that staff did not provide adequate supervision on 02/15/24 when one teacher was left to supervise 14 children for 5 minutes and that staff did not provide supervision to C1 during the incident on 02/27/2024 for 20 minutes.

The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D.

Exit interview was conducted with facility representative, Area Supervisor, Kim Rodgers.

Notice of site visit must be posted for 30 days. Appeal rights provided during visit.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/07/2024 04:47 PM - 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: HEAD START - LINCOLN CENTER
FACILITY NUMBER: 490111008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/08/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by:
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A plan of correction has already been implemented with a staff training on active supervision and transitions conducted on 02/27/24. Notes and a staff sign in was provided to LPA Strother during today's visit. LPA reviewed the "Transtion Safety and Supervision Child Tracking Sheet" and discussed it's use with Area Supervisor.
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Based on record review of the Unusual Incident Reports submitted by the facility with admission that one staff was left with a group of 14 children for 5 minutes on 02/15/24 and child (C1) was alone in a classroom without supervision for 20 minutes on 02/27/24, which poses a potential health, safety, or personal rights risk to persons in care.
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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3