493002241-8-17-2022-01-CC-SPHG-CHDLN4-20220817085339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493002241
Report Date: 07/29/2022
Date Signed: 08/17/2022 08:54:18 AM

Document Has Been Signed on 08/17/2022 08:54 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:	CHILDREN'S LEARNING CENTER - PRESCHOOL		FACILITY NUMBER:	493002241
ADMINISTRATOR:	ALI, NADEREH		FACILITY TYPE:	850
ADDRESS:	1213 W. STEELE LANE		TELEPHONE:	(707) 575-7486
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	39	CENSUS: 15	DATE:	07/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Nadereh Ali & Jeanette "Jenny" Gillespie		TIME COMPLETED:	01:50 PM

NARRATIVE

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A required one year inspection was made to the facility by Licensing Program Analysts (LPA), Sebastian Phouthavong. LPA met with Director, Nadereh Ali (L1). The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances or exemptions. Facility representative, Nadereh Ali 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 6:00am-6:30pm, Monday-Friday. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. L1 stated there are no poisons in the facility, and none were observed during this inspection. LPA observed 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 indoors and outdoors using water pitcher. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the a room. LPA observed food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. Menus are posted in the entry of the school. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. Last emergency drill was conducted on 06/2022. LPA observed the playground equipment and surface areas were in safe condition. There is wood chip cushioning underneath play equipment to absorb falls. There were no bodies of water observed on the site. L1 stated no weapons are stored on site, and none were observed.

Continued on LIC 809-C.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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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Document Has Been Signed on 08/17/2022 08:54 AM - 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CHILDREN'S LEARNING CENTER - PRESCHOOL	FACILITY NUMBER: 493002241
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. The licensee did not comply with the section cited above. LPA observed ten children's Immunization Records (IR) were not transcribed onto the blue CDPH 286 form, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/19/2022
	Plan of Correction
1 2 3 4	Licensee stated she would transfer five immunization records onto the CDPH 286 forms, and the Licensee would submit her evidence of completion to the Department by 08/19/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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: CHILDREN'S LEARNING CENTER - PRESCHOOL	FACILITY NUMBER: 493002241
	VISIT DATE: 07/29/2022

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During today's inspection, staffing ratios were being met, fifteen children were being supervised by four staff. The facility was operating within the licensed capacity and ratio requirements. At least one staff member present, L1, during the inspection possessed current CPR and First Aid certifications. Ten children’s records were reviewed at 10:30AM were missing CDPH 286 forms. A Type B deficiency was cited at the center. Four staff files were reviewed at 11:15AM and contained all records as required.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview conducted and report was reviewed with facility representative, Nadereh Ali.

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 at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC809 (FAS) - (06/04)

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