480102614-2-23-2022-01-CC-MAUN-CBWV6R-20220223151000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480102614
Report Date: 02/23/2022
Date Signed: 02/23/2022 03:10:14 PM

Document Has Been Signed on 02/23/2022 03:10 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:	ST. BASIL'S PRESCHOOL		FACILITY NUMBER:	480102614
ADMINISTRATOR:	BUTLER, LISA		FACILITY TYPE:	850
ADDRESS:	1225 TUOLUMNE STREET		TELEPHONE:	(707) 642-5966
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY: 44	TOTAL ENROLLED CHILDREN: 48	CENSUS: 35	DATE:	02/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lisa Butler - Center Director		TIME COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A Required-1 Year inspection was made to the facility by Licensing Program Analyst (LPA), M. Augustin. The facility file was reviewed prior to this visit. This program is not a Title 5 funded program and did not have any standing waiver(s). A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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 7:30am - 5:30pm, Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The 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). 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 both indoors and outdoors. The children bring their own cup to retrieve water from a classroom sink faucet(s). The children’s bathroom is in safe and sanitary condition and contained four toilets and four sinks. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. A Menu was posted in an area accessible for review by the child's authorized representative. The Daily Activities schedule, the Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist, Personal Rights, Parents’ Rights (PUB 393), California Child Passenger Safety Law, and Local county public health contact information, were posted in a prominent area. Garbage can(s) with solid waste had tight fitting lids. LPA observed a working carbon monoxide and hardwired smoke detectors, and a fully charge fire extinguisher rated at least 2A10BC. The playground equipment and surface areas were in safe condition. There is rubber mulch cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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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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: ST. BASIL'S PRESCHOOL	FACILITY NUMBER: 480102614
	VISIT DATE: 02/23/2022

NARRATIVE

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The Center Director (CD) stated no weapons are stored on site and none were observed. The facility roster of the children currently in care was reviewed and appeared to be complete. During today's inspection, staffing ratios were being met, and 35 children were being supervised by Center Director, two Teachers and two Aides. (Continue to LIC 809-C)

The facility was operating within the licensed capacity. The Center Director furnished a current EMSA approved Pediatric CPR and First Aid certification which expire on 08/10/23. The children’s sign-in/out procedure was reviewed and contained authorized representatives’ full signature and time signed in, however; several children had not been signed out on several different dates. Five staff (CD, S1-S4) records were reviewed at 10:16am revealed CD, S1 and S2’s AB 1207 Mandated Reporter Training certificates were expired, and CD did not have proof of 8 hours completion for Preventive Health and Safety (a Technical Violation was issued for this deficiency). Ten children’s (C1-C10) records were reviewed at 11:46am and the records contained Physician’s Report (LIC 701), Immunization record (IR), transcribed CDPH 286, Child’s Preadmission Health History (LIC 702), Admission Agreement and Identification and Emergency Information (LIC 700). The facility conducted an emergency disaster drill within last six months and the last drill was conducted on 10/21/21.

The facility is providing Incidental Medical Services to the children in care and a Plan for Providing IMS is on file. Two children’s IMS medications were reviewed, and the medication containers contained a valid label with the children's names, device instruction(s) and instruction from the child(ren)’s medical provider. The Department’s IMS policy was discussed with the Center Director. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Center Director. Exit interview conducted and report was reviewed with the Center Director, Lisa Butler.

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

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/23/2022 03:10 PM - It Cannot Be Edited

Created By: Melchisedeck Augustin On 02/23/2022 at 01:16 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: ST. BASIL'S PRESCHOOL	FACILITY NUMBER: 480102614
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(a)(1)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's review of the children's sign in/out procedure which revealed that several children had not been signed out by their authorized representatives on several different dates. 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: 03/05/2022
	Plan of Correction
1 2 3 4	Center Director stated she would double check the children's sign in/out procedure in the morning, and CD would submit a written statement detailing how she intends to comply with CCR 101229.1(a)(1). Email: melchisedeck.augustin@dss.ca.gov & Fax: (707) 588-5099

Type B

Section Cited

HSC

1596.8662(b)(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
1 2 3 4	Based on staff records reviewed at 10:16am which revealed CD, S1 & S2 did not have a current AB 1207 Mandated Reporter Training certificates. 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: 04/09/2022
	Plan of Correction
1 2 3 4	Center Director stated staff would complete the online AB 1207 Mandated Reporter Training module at, mandatedreporterca.com, and CD would submit current certificates for CD, S1 & S2 to the Department by 04/09/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

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: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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: ST. BASIL'S PRESCHOOL	FACILITY NUMBER: 480102614
	VISIT DATE: 02/23/2022

NARRATIVE

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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: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC809 (FAS) - (06/04)

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