493002286-9-23-2019-01-CC-ASTR-BGAUSL-20190923155030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493002286
Report Date: 09/23/2019
Date Signed: 09/23/2019 03:50:42 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:	SUMMERFIELD WALDORF SCHOOL		FACILITY NUMBER:	493002286
ADMINISTRATOR:	CATHERINE SCHLAGER		FACILITY TYPE:	850
ADDRESS:	655 WILLOWSIDE ROAD		TELEPHONE:	(707) 575-7194
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY:	58	CENSUS: 56	DATE:	09/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Catherine Schlager		TIME COMPLETED:	04:05 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 random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. The facility file was reviewed prior to this visit. A review of the personnel report on file 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 facility’s operating hours are 8:30am-12:30pm with a 12:30pm-3:00pm extended care Monday, Tuesday and Wednesday and 8:30am-12:30pm Thursday and Friday. This facility operates the first week in September through the first week of June, closed the remainder of June and all of July and August. 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 stated that there are no poisons stored on site and none were observed during today's inspection. 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 both indoors and outdoors provided by a water jug and reusable cups. The children's bathrooms are in safe and sanitary condition. 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. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is woodchip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and 56 children were being supervised by six teachers/aides. The facility was operating within the licensed capacity. At 2:46 pm the school registrar, Staff 1 (S1) stated that although she believes the Director is current on her CPR and First Aid certification, a certificate of proof is not available at this time. Upon record review no other staff member present during the visit possessed current CPR and First Aid certifications on file. Continue on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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: SUMMERFIELD WALDORF SCHOOL	FACILITY NUMBER: 493002286
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/23/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/07/2019 Section Cited	1 2 3 4 5 6 7	At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on interview and record review, the licensee failed to provide documentation of at least one staff member who is current with training in pediatric First Aid and CPR during today's inspection, which poses a potential Health, Safety or Personal RIghts risk to the children in care.	8 9 10 11 12 13 14	S2 will email proof of current First Aid/CPR for the director to LPA Strother by 10/07/19.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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: SUMMERFIELD WALDORF SCHOOL	FACILITY NUMBER: 493002286
	VISIT DATE: 09/23/2019

NARRATIVE

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The sign-in/sign-out procedure was reviewed and in compliance. 18 children’s records were reviewed at 12:09pm, and contained all records to be maintained. Four staff records were reviewed at 2:05pm and contained documentation of education and training as required. This facility is not currently providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Director. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochure, were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

An exit interview was conducted and Plans of corrections were reviewed and developed with the Licensee. Appeal Rights were provided and discussed with, Catherine Schlager whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC809 (FAS) - (06/04)

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