493009469-2-18-2020-01-CC-YYAG-BLWMV6-20200218085614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493009469
Report Date: 02/13/2020
Date Signed: 02/18/2020 08:56:23 AM

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:	NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN		FACILITY NUMBER:	493009469
ADMINISTRATOR:	PORTER,NICOLE		FACILITY TYPE:	850
ADDRESS:	520 MONTE VISTA AVEUNE, RM 8&9		TELEPHONE:	(707) 473-4382
CITY:	HEALDSBURG	STATE: CA	ZIP CODE:	95448
CAPACITY:	54	CENSUS: 33	DATE:	02/13/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:02 PM
MET WITH:	Nicole Porter		TIME COMPLETED:	02:28 PM

NARRATIVE

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An unannounced case management inspection visit was made to the facility by Licensing Program Analyst (LPA) Y.Yang in response to a self-reported, unusual incident report (UIR) received by the department on 02/06/2020. During today’s inspection visit, LPA met with site supervisor Nicole Porter to discuss the incident.

The facility reported that on 01/29/2020 at approximately 03:00pm, seven children from classroom nine were left in their classroom without the direct supervision and observation of a teacher for a maximum of five minutes.The site supervisor reported that teacher S2, who was assigned to and working in "classroom nine" was asked by teacher S1 of adjoining "classroom eight" to provide language translation services for a child care client. The site supervisor stated that due to a mis-communication between S2 and S1, the two teachers did not swap classrooms. Instead, the site supervisor reported that S1 remained in "classroom eight" with teacher S4 and eight children while S2 attended to the childcare client. The site supervisor reported that teacher S3 was present in "classroom nine," working on her "regularly scheduled paper time." However, S3 was seated in an off-limits "teacher's area" behind a movable barrier approximately four feet in height. Based on interviews conducted, S3 was not providing supervision to the children at the time and was not aware that S2 was not present in the classroom.

The site supervisor reported that she requested that all facility staff provide her with a written statement of their account of the incident. The site supervisor reported that a staff meeting was called and a training on supervision was provided by her to her staff. During today's case management inspection visit, LPA obtained a copy of written statements from facility staff as well as signed training documents from facility staff pertaining to the facility's supervision plan.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

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: NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN	FACILITY NUMBER: 493009469
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/17/2020 Section Cited	1 2 3 4 5 6 7	Care and Supervision. 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 was not met as evidenced by: the site supervisor's admission on 02/13/2020 at 12:25pm that on 01/29/2020 at approximately 03:00pm, seven children from "classroom 9" were left without the supervision or observation of a teacher for up to five minutes due to a miscommunication between staff members S1 and S2. This presents a potential threat to the health and safety of children in care.
	1 2 3 4 5 6 7
	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: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

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: NORTH BAY CHILDRENS CENTER FITCH MOUNTAIN	FACILITY NUMBER: 493009469
	VISIT DATE: 02/13/2020

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Community Care Licensing was not notified by telephone or fax within the Department's next working day and during its normal business hours, as required. The written UIR was received by the Department on 02/06/2020. During today's visit, staff were observed to be providing appropriate care and supervision and operating within ratio. This report was read and reviewed with the site supervisor. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809-D. Appeal rights provided.

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

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

LIC809 (FAS) - (06/04)

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