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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009809
Report Date: 11/02/2022
Date Signed: 11/02/2022 05:34:24 PM


Document Has Been Signed on 11/02/2022 05:34 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:L'ACADEMY PRESCHOOL FAIRFIELDFACILITY NUMBER:
483009809
ADMINISTRATOR:SABRINA OLDANIFACILITY TYPE:
850
ADDRESS:5150 WISEMAN WAYTELEPHONE:
(707) 639-3773
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:98CENSUS: 38DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ivette Pimentel - Acting DirectorTIME COMPLETED:
04:15 PM
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A required annual inspection of the facility was conducted by Licensing Program Analysts (LPA) C. Fernandes-Goes. The facility file was reviewed prior to this inspection. 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. Facility Representative, Acting Director, Yvette Pimentel 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.

LPA met with the facility’s, Acting Director, Yvette Pimentel (S1). This program is license as a preschool. The facility’s operating hours are 7:30am - 5:30 pm, Monday-Friday. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were reviewed and discussed with S1. LPA requested the facility submit an updated LIC 610 Emergency Preparedness. Sign in/out records are done through a parent portal called 1Core which was reviewed and in compliance. LPA advised acting director to ensure that facility keeps a copy of children’s names and count that can be used in an emergency. There were no danger items accessible to children in the classrooms. Cleaning compounds were not accessible to children and kept on a kitchen hallway closet. S1 stated there are no poisons in the facility, and none were observed during this inspection. LPA observed 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 by individual water bottles. 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 director office or empty classroom if needed. LPA observed food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Carla Fernandes-GoesTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: L'ACADEMY PRESCHOOL FAIRFIELD
FACILITY NUMBER: 483009809
VISIT DATE: 11/02/2022
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LPA observed a working carbon monoxide detector in the center. LPA observed the playground equipment and surface areas were in safe condition. There is rubber cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed on the site. S1 stated no weapons are stored on site, and none were observed.

During today's inspection, staffing ratios were being met, 38 children were being supervised by 5 staff. The facility was operating within the licensed capacity and ratio requirements. At least one staff member, S1 present during the inspection possessed current CPR and First Aid certifications, which expires on 7/2023. Five children’s records and five staff records were reviewed and acting director understands that all required documents must be available for the Department to review.

This facility doesn’t provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: http://www.ada.gov/childqanda.htm

Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative, Yvette Pimentel.

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/i

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Carla Fernandes-GoesTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: L'ACADEMY PRESCHOOL FAIRFIELD
FACILITY NUMBER: 483009809
VISIT DATE: 11/02/2022
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Department is requesting the following to be submitted to CCLD ASAP

* Proof of Disaster Drill
LIC200A (Application) – Update to notify of new director (if in charge of facility)
• LIC308 (Designation of Facility Responsibility)
* Copy of Board resolution meeting if entity is a corporation or LLC
• LIC501 (Personnel Record) – updated and current
• LIC503 (Health Screening) with TB clearance & Proof of Immunity to Measles, Pertussis and
Influenza (or a written declaration that the influenza vaccination has been declined)
• LIC508 (Criminal Record Statement)
• LIC9096 (Evaluation of Director Qualifications) We complete form.
• Copy of official transcripts, site supervisor permit, child development program director permit.
• Verification of work experience.
• Current pediatric CPR/First Aid and Preventative Health Practices (should include nutrition and effects of lead exposure components)
• LIC500 (Personnel Report)
• LIC610 (Emergency Disaster Plan)
• LIC9108 (Statement Acknowledging Requirement to Report Suspected Child Abuse).
• Certificate for Operation and Recordkeeping section of the child care center orientation.
• Mandated Reporter Training Certificate from: www.mandatedreporterca.com
Must complete General Training & Child Care Provider Training.
• Must have criminal record clearance and association to facility. Send transfer documents with
*copy of California Driver’s License or ID.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Carla Fernandes-GoesTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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