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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111657
Report Date: 04/07/2021
Date Signed: 04/07/2021 06:11:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BRUSH CREEK MONTESSORI SCHOOLFACILITY NUMBER:
490111657
ADMINISTRATOR:BURCHETT, JEDFACILITY TYPE:
850
ADDRESS:1569 BRUSH CREEK ROADTELEPHONE:
(707) 539-7980
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:78CENSUS: 18DATE:
04/07/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Candace MackeyTIME COMPLETED:
04:30 PM
NARRATIVE
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While Licensing Program Analyst (LPA) Amy Strother was conducting a remote Facetime and then Zoom Tele-Inspection visit with Director Candace Mackey (D1) in relation to another matter, LPA Strother made the following observations during a tour of the facility at 1:52pm. The Amber classroom and the Redwood classroom each had two teachers present during the tour. D1 identified each teacher by name during the tour. LPA Strother reviewed the facilities personnel report summary and observed that one teacher from each of the classrooms, Staff 1 and Staff 2 (S1 and S2) were not included on the list. Upon further investigation, LPA Strother concluded that S1 and S2 have current criminal record clearances, but are not currently associated to the facility. D1 stated that S1 was hired prior to her own employment at the facility so she assumed she was associated and S2's paperwork was emailed to the Rohnert Park Child Care's general email on 01/17/21 from her facility email address. LPA Strother has not been able to receive email's from D1's facility email. D1 had been notified of and acknowledged the fact that emails from D1's facility email had not been received in the past.

During the visit at 2:23pm, LPA Strother requested a review of staff records. During the record review D1 was missing proof of the mandated reporter training and has been employed since 12/18/2020. D1 stated she had not completed the training, and that she did not have the certificate.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Civil Penalties were assessed. Appeal Rights were provided.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BRUSH CREEK MONTESSORI SCHOOL
FACILITY NUMBER: 490111657
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2021
Section Cited

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101170(e)(2) Criminal Record Clearance. ...prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f).

This requirement is not met as evidenced by:
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This requirement is not met as evidenced by: Based on observation/interview/record review S1 and S2 are not currently associated to the facility and a transfer request was not completed which poses a potential safety risk to the children in care.
*A civil penalty applies.
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Type B
04/14/2021
Section Cited

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1596.8662 Availability of information regarding...reporting child abuse...proof of completion. (b)(1)On or before March 30, 2018,...licensed child care provider...shall complete the mandated reporter training...and shall complete...every two years...
This requirement is not met as evidenced by:
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Based on interview, D1 did not complete the mandated reporter training which poses a potential Health, Safety or Personal Rights risk to the children 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: 04/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2021
LIC809 (FAS) - (06/04)
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