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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413132
Report Date: 03/05/2024
Date Signed: 03/05/2024 05:01:02 PM

Document Has Been Signed on 03/05/2024 05:01 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:NORTHMINSTER PRESBYTERIAN INFANT CAREFACILITY NUMBER:
274413132
ADMINISTRATOR:ANDY RAUSCHFACILITY TYPE:
830
ADDRESS:315 EAST ALVIN AVENUETELEPHONE:
(831) 449-2717
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
03/05/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jerrianna BighamTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPA), Elizabeth Larios, met with Director, Jerrianna Bigham, for an unannounced Required - 3 Year inspection. LPA toured the facility both indoor and outdoor areas during prior inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. Days and hours of operation are Monday through Friday 7:00 AM to 5:30 PM. The facility is licensed to serve a maximum of twelve (12) children ages birth to two (2) years in infant room.

LPA observed that the facility is not clean, safe, sanitary, and in good repair for children, staff, and visitors. The facility has adequate ventilation, including central air conditioning/heating. Staff state that the facility has a custodian that cleans the facility Monday through Friday. Director understands that the facility must be kept free of flies and other insects & rodents. LPA observed that not all furniture and equipment is in good condition and safe for the children. The infant changing table has raised sides that are at least 3 inches in height. The infant changing table has a vinyl changing pad that is at least 1 inch think and in good condition. Napping equipment is appropriate.

Drinking water is readily available for the children via water dispensers/water filter and individualized water bottles. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Director states that there are no weapons or firearms on the premises. The facility has functioning smoke and carbon monoxide detector in the facility.

Facility does not provide food. Per Director children bring there food from home. Food storage such refrigerator, and microwave areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NORTHMINSTER PRESBYTERIAN INFANT CARE
FACILITY NUMBER: 274413132
VISIT DATE: 03/05/2024
NARRATIVE
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The facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children. There are no poisons at the facility. LPA observed a complete First Aid kit in the facility. Director states that the facility does not administer any medications at this time. Director understands that smoking is not allowed on the facility premises. The playground area utilized by children are surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA did not observe any bodies of water. Director states that the facility does not provide transportation.

LPA reviewed children's and staff files during today's inspection. Each child's file reviewed contains the required forms, including Needs & Services Plans. Not all staff files reviewed contain the required forms, including transcripts/verification of experience/immunization records, & Health Screening Report. Not all staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on 1/08/2024. Staff have current CPR and First Aid certifications on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).

Director understands the conditions, limitations, and capacity specifications of the facility license. Director understands that children shall be visually supervised at all times and never left unattended. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the infant classroom.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Director 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NORTHMINSTER PRESBYTERIAN INFANT CARE
FACILITY NUMBER: 274413132
VISIT DATE: 03/05/2024
NARRATIVE
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Exit interview conducted and report was reviewed with the Director Jerrianna Bigham. Deficiencies issued during today's inspection and appeal rights were given.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 03/05/2024 05:01 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 03/05/2024 at 03:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NORTHMINSTER PRESBYTERIAN INFANT CARE
FACILITY NUMBER: 274413132

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above LPA observed broken toys, unsanitary stuffed animals, children chair/sofa, adult chair, broken cabinet, and crack flooring in hallway that leads to infant classroom that is a tripping hazard in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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 Licensee shall submit pictures to department as proof repairs were completed and new toys, children chair, and adult chair were purchased or replaced. Licensee will submit a written plan by POC date 3/12/2024 indicating how they will keep the infant care, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
Type B
Section Cited
CCR
101170(e)
Criminal Record Clearance
(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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above staff (S4) is not associated to the facility in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee shall submit a transfer request for staff (S4) by POC date 3/12/2024 to the department.
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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 03/05/2024 05:01 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 03/05/2024 at 03:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NORTHMINSTER PRESBYTERIAN INFANT CARE
FACILITY NUMBER: 274413132

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above three staff (S1, S2 & S4) have no immunization record on file) and staff (S1, S2 , S3, & S4 have no influenza record in file) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee shall submit proof of immunization's for measles, pertussis and influenza for staff (S1, S2 , S3, & S4) and proof of immunization for influenza or statement declining influenza by POC date of 03/12/2024.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above staff (S3) did not have a Health Screening Report LIC 503 in file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee shall submit a completed Health Screening Report LIC 503 for staff (S3) by POC date 3/12/2024.
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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 03/05/2024 05:01 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 03/05/2024 at 03:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NORTHMINSTER PRESBYTERIAN INFANT CARE
FACILITY NUMBER: 274413132

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above staff (S1 & S4) did not have a mandated reporter certificate in file in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee shall submit a mandated reporter certificate of completion for staff (S1 & S4) by POC date 3/12/2024 to the department.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above child (C4 & C6) did not have a Physician's Report LIC 701 on file in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2024
Plan of Correction
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Licensee shall submit a completed Physician's Report LIC 701 for child (C4 & C6) by POC date 3/12/2024 to the department.
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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024


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