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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009941
Report Date: 11/15/2022
Date Signed: 11/15/2022 02:35:44 PM

Document Has Been Signed on 11/15/2022 02:35 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:TAYLOR MADE ACADEMYFACILITY NUMBER:
483009941
ADMINISTRATOR:TAYLOR, JOANNAFACILITY TYPE:
850
ADDRESS:600 E TABOR AVENUETELEPHONE:
(707) 319-7774
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 30TOTAL ENROLLED CHILDREN: 18CENSUS: 11DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee Joanna TaylorTIME COMPLETED:
02:45 PM
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An annual inspection was made to the facility by Licensing Program Analyst (LPA), Elpidia Hernandez Torres. The facility file was reviewed prior to this inspection. A review of the personnel report on 11/14/2022 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This program is privately operated.

The facility’s operating hours are 07:00AM- 05:30PM, 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. The regulation that poisons are locked with a key or combination lock was reviewed. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors through the use of water dispensers. The children’s bathrooms were in safe and sanitary condition. A current menu was posted in the lobby. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is sponge matt cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The licensee stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were 11 children being supervised by two teachers. The facility was operating within the licensed capacity. At least one staff member present during the visit (S2) possessed current CPR and First Aid certifications. Five children’s records were reviewed at 10:01AM, and contained identification forms with authorized representative information. Four of the five children's records were missing LIC 701 Physician's report a deficiency was cited. All five children were missing admissions agreements an advisory note was issued. Three staff records were reviewed at 12:00PM, and contained health screening forms. Continued on 809-C
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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: TAYLOR MADE ACADEMY
FACILITY NUMBER: 483009941
VISIT DATE: 11/15/2022
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 Two staff members were not able to produce updated AB 1207 Mandated report training certificates an advisory note was issued. The sign in/out procedure was reviewed, three out of the five children were not signed in or out on two or more occasions an advisory note was issued.

Licensee 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.

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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee JoAnna Taylor

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: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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Document Has Been Signed on 11/15/2022 02:35 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 11/15/2022 at 02:06 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: TAYLOR MADE ACADEMY
FACILITY NUMBER: 483009941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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, 4/5 childrens' record's reviewed were missing LIC 701 Physcian's report. 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: 12/06/2022
Plan of Correction
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Licensee agreed to submit a form that states " I have recieved LIC 701" in which the guardians of the four children missing LIC 701 have recieved the from from the guardian and parents need to sign on the same document the day they turn in LIC 701 to Licensee. Licensee will email mail or fax that form the LPA Hernandez Torres. Email: Elpidia.hernandez-torres@dss.ca.gov, Mail: 1450 Neotomas Ave Suite 100 Santa Rosa CA 95405, 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:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022


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