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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480100824
Report Date: 06/16/2023
Date Signed: 06/16/2023 03:34:41 PM

Document Has Been Signed on 06/16/2023 03:34 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:VALLEJO PARENT NURSERY SCHOOLFACILITY NUMBER:
480100824
ADMINISTRATOR:JOANNE SOUVERCAZEFACILITY TYPE:
850
ADDRESS:500 AMADOR STREETTELEPHONE:
(707) 644-7576
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 48TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/16/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Joanne Souvercase - LicenseeTIME COMPLETED:
03:45 PM
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A required one-year inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. LPA met with Licensee, Joanne Souvercaze (LS) and Center Director, Sarah Otanez (CD). The facility follows the Vallejo City Unified School District’s calendar, is currently closed for summer break, and as such, the facility did not have any children in care. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances or exemptions. Licensee and Center 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.

The facility’s operating hours are 9:15AM-1:15PM, Monday-Friday. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. LPA did not observe any poison(s) at the facility. Licensee stated there were no firearm(s) and/or other dangerous weapon(s) stored on site. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe, and in good condition. There is drinking water available to children indoors and outdoors. The facility had water fountains that are accessible to the children. The facility posted its lead test result on the parent board, near the front entrance. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is in the office. Garbage cans containing solid waste have tight fitting lids. Menus are posted on the parent board at the front entry and on the refrigerator. There is a working smoke detector, carbon monoxide detector and fire extinguisher that is rated at least 2A10BC. Last emergency drill was conducted on 05/23/2023. The playground equipment and surface areas appeared to be in safe condition and there were wood chips underneath the high climbing equipment to absorb falls. There were no bodies of water observed on the site. Continued on LIC 809-C.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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 06/16/2023 03:34 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 06/16/2023 at 01:59 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VALLEJO PARENT NURSERY SCHOOL

FACILITY NUMBER: 480100824

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/16/2023

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 LPA's review of three staff (LS, CD & S1) records at 1:08pm which revealed that LS, CD & S1 did not have a current AB 1207 Mandated Reporter Training certificate. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2023
Plan of Correction
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Licensee stated she would ensure that all staff complete the online AB 1207 Mandated Reporter raining module at mandatedreporterca.com, and Licensee intends to submit staff's current AB 1207 certificates, along with the General training certificate to the Department by 07/31/23 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023


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: VALLEJO PARENT NURSERY SCHOOL
FACILITY NUMBER: 480100824
VISIT DATE: 06/16/2023
NARRATIVE
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The facility was operating within the licensed capacity and ratio requirements. At least one staff member present during the inspection possessed current pediatric CPR and First Aid certification, which expire 8/23/2023. Children’s records were not review due to a zero census of children in care. Three staff (LS, CD & S1) records were reviewed at 1:08PM which revealed LS, CD, & S1’s records did not contain current AB 1207 Mandated Reporter Training certificate.

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. LPA requested a Plan for Providing IMS from the Licensee.

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, Licensee and Center Director. The following violation of the California Code of Regulations, Title 22; Division 06, were observed: see LIC 809D. Appeal Rights were provided

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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