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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009824
Report Date: 04/03/2024
Date Signed: 04/25/2024 02:39:52 PM

Document Has Been Signed on 04/25/2024 02:39 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:NAPA VALLEY COLLEGE CHILD & FAMILY-INFANT BY NCOEFACILITY NUMBER:
283009824
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		DE LA CRUZ, MAYRAFACILITY TYPE:
830
ADDRESS:2277 NAPA VALLEJO HWY BLD 3000TELEPHONE:
(707) 256-7040
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 26DATE:
04/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mayra De La CruzTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Glenn Ouye met with Site Supervisor Mayra De La Cruz to discuss an unusual incident which occurred on Wednesday, March 27 2024 at approximately 11:55 am in the toddler program.

The incident involves child C1 being left outside in the outdoor play area for 5 minutes before staff realized that the child was not in the classroom. Staff were having groups of 4 children enter the classroom at a time. The final group had three children but only two entered the classroom. One of the teachers is an NCOE employee but is a roving teacher between sites and it was her first day in that particular classroom. The program does have a transition process to count the total number of children in each room but because the teacher was new to the class there was a breakdown in communication between the staff inside and the staff outside of the classroom. A child was also ill and throwing up at the same time so this created a distraction. When the children were inside of the classroom one of the staff did a head count and realized that C1 was missing. She noticed the child outside and retrieved he child.

Based on the interview with the Site Supervisor there was an absence of supervision of child C1 for 5 minutes.

Based on interview, it has been determined that staff did not provide supervision to C1 during the incident on 03/27/2024. The following violation of the California Code of Regulations, Title 22; Division 6, Health and Safety Code was observed: see LIC 809D. Appeal Rights were provided.

Continued on LIC809-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: NAPA VALLEY COLLEGE CHILD & FAMILY-INFANT BY NCOE
FACILITY NUMBER: 283009824
VISIT DATE: 04/03/2024
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor, Mayra De La Cruz.

LPA Ouye informed Site Supervisor, Mayra De La Cruz that this report dated 04/03/2024 documents one Type A citation. Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Ouye informed the Site Supervisor to provide a copy of this licensing report dated 04/02/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/25/2024 02:40 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/23/2024 01:11 PM


Created By: Glenn Ouye On 04/03/2024 at 11:51 AM
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NAPA VALLEY COLLEGE CHILD & FAMILY-INFANT BY NCOE
FACILITY NUMBER: 283009824

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time...
This requirement has not been met as evidenced by
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Site Supervisior agrees to provide the department with the written plan on the children head count during transitions. The plan will also include
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On 03/27/24, C1 was left in the outdoor play area unsupervised resulting in an absence of supervision for at 5 minutes at 11:55am which poses an immediate Health and Safety risk to children in care.
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training for all staff as well as roving staff who are providing coverage at the site.
This will clear the deficiency.

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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:Leslie Lepori
LICENSING EVALUATOR NAME:Glenn Ouye
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024


LIC809 (FAS) - (06/04)
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