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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493002686
Report Date: 04/06/2022
Date Signed: 04/06/2022 01:22:27 PM


Document Has Been Signed on 04/06/2022 01:22 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:TINY TREASURES PRESCHOOL, INC.FACILITY NUMBER:
493002686
ADMINISTRATOR:FIORI, ELIZABETHFACILITY TYPE:
850
ADDRESS:180 WIKIUP DRIVETELEPHONE:
(707) 544-8469
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:60CENSUS: 45DATE:
04/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Beth FioriTIME COMPLETED:
01:40 PM
NARRATIVE
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 An inspection was conducted at the facility by Licensing Program Analysts (LPAs) Amy Strother and Sebastian Phouthavong. During the inspection, LPAs toured the facility with the Director (D1). LPAs observed six staff, Staff 1 - Staff 6 (S1-S6) caring and supervising a total of 45 children, operating within the required staffing ratios. Upon review of the facility roster, LPAs did not observe Staff 3 (S3) on the list of criminal record cleared and associated staff. LPAs interviewed D1 who stated that S3 has been working at the facility for 2 days. D1 stated she called Licensing and confirmed that S3 had an active criminal record clearance on file, but had not yet submitted the required paperwork to transfer S3's clearance to the facility.

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

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.

Exit interview conducted and report was reviewed with the licensee Beth Fiori.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
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 04/06/2022 01:22 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: TINY TREASURES PRESCHOOL, INC.
FACILITY NUMBER: 493002686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2022
Section Cited

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101170(e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall 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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Based on observation, record review, and interview the licensee did not associate 1 of 6 staffs criminal record clearances to the facility. Staff 3's (S3's) criminal record clearance was not transferred to the facility prior to the first day of employment.
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Director will request a copy of the facility profile and ensure S3 is associated prior to return to work. Director will request roster to verify staff hired in the future are cleared and associated prior to first day of employement.

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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: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
LIC809 (FAS) - (06/04)
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