490102646-12-12-2022-01-CC-ASTR-CM3244-20221212160319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490102646
Report Date: 12/12/2022
Date Signed: 12/12/2022 04:03:34 PM

Document Has Been Signed on 12/12/2022 04:03 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:	BETH AMI COMMUNITY NURSERY SCHOOL		FACILITY NUMBER:	490102646
ADMINISTRATOR:	DREZNER, CAREN		FACILITY TYPE:	850
ADDRESS:	4676 MAYETTE AVENUE		TELEPHONE:	(707) 360-3030
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY: 75	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	12/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Caren Drezner		TIME COMPLETED:	04:17 PM

NARRATIVE

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A required annual inspection of the facility was conducted by Licensing Program Analyst (LPA) Amy Strother. 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, Director Caren Drezner 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 Center Director, Caren Drezner (D1). The facility’s operating hours are 8:00a.m. - 5:00 p.m., Monday-Friday. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. Sign in/out records were reviewed on the Brightwheel Application and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible. D1 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 use of individually labelled water bottles brought from home. D1 stated that if a water bottle needs to be refilled, staff fill it in the facility kitchen, using filtered water. 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 located in the Director's office on a cot. LPA observed a working carbon monoxide detector in the facility. LPA observed the playground equipment and surface areas were in safe condition. There is sand underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed on the site. D1 stated no weapons are stored on site, and none were observed.

Continued on LIC 809-C.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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: BETH AMI COMMUNITY NURSERY SCHOOL	FACILITY NUMBER: 490102646
	VISIT DATE: 12/12/2022

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During today's inspection, staffing ratios were being met, 7 children were being supervised on the playground by 3 staff. The facility was operating within the licensed capacity and ratio requirements. At least one staff member present during the inspection possessed current CPR and First Aid certifications, which expires 07/2023. Five children’s records were reviewed and contained the required documents. Five staff records were reviewed. Two out of 5 staff files (S1 and S4) did not contain form LIC503 Health Screening as required. One of out 5 staff files (S4) did not contain immunization records, showing immunity to or immunization against Measles and Pertussis as required.

This facility 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

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

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, Caren Drezner.

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/inspection-process

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/12/2022 04:03 PM - It Cannot Be Edited

Created By: Amy Strother On 12/12/2022 at 03:23 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: BETH AMI COMMUNITY NURSERY SCHOOL	FACILITY NUMBER: 490102646
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in one out of five staff files (file for S4) did not contain proof of immunity to Measles and Pertussis which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2023
	Plan of Correction
1 2 3 4	D1 stated she will have S4 make an appointment to have a Titer blood test done to prove immunity to Measles and Pertussis and provide a copy of either immunity to or immunization of Measles and Pertussis to LPA by 01/12/22 and place a copy in S4's file. amy.strother@dss.ca.gov

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two out of five files. S1 and S4 did not have health screening on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2023
	Plan of Correction
1 2 3 4	D1 will provide S1 and S4 with the LIC503 and ask them to complete the health screening and turn in the completed LIC503 to be placed on file and emailed to LPA Strother by 01/12/22. amy.strother@dss.ca.gov

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:

Alexis Hollon

LICENSING EVALUATOR NAME:

Amy Strother

LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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