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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009955
Report Date: 07/01/2022
Date Signed: 07/01/2022 12:02:11 PM

Document Has Been Signed on 07/01/2022 12:02 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 CHILDRENS PRESCHOOL CENTERFACILITY NUMBER:
493009955
ADMINISTRATOR:RENEE TAYLORFACILITY TYPE:
850
ADDRESS:500 NORTH MAIN STREETTELEPHONE:
(707) 827-6200
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 8DATE:
07/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Renee TaylorTIME COMPLETED:
10:30 AM
NARRATIVE
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An unannounced case management inspection of the facility was conducted by Licensing Program Analyst Jennifer Velasco (LPA) in response to a self reported 06/22/2022 incident involving a child (C1) and a staff (S1). During today’s visit, the LPA met with facility Licensee and Director Renee Taylor (D1) to discuss the incident. D1 reported that on 06/22/22, C1 and another child (C2) were playing together under the supervision of S1, when C1 pulled C2’s hair, and then S1 pulled C1’s hair. D1 reported that staff S1 was responsible for a total of two children at the time. D1 reported a parent (A1) notified D1 of the incident. D1 stated S1’s employment was then immediately terminated and S1 was ordered to vacate the facility. D1 reported all staff will receive additional training regarding personal rights and behavior management strategies. D1 reported this incident was reported by S1 to child’s C1’s authorized representatives and by D1 to CCLD as required per regulations. During today’s case management visit, LPA observed eight children being supervised by one staff member. No children were observed to be left without supervision. Based on available information, it has been determined that S1 violated C1’s personal rights during the incident on 06/22/2022. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. LPA informed D1 that this report dated 07/01/2022 documents a Type A citation and shall therefore be posted for 30 consecutive days, as it documents an immediate risk to the health, safety, or personal rights of children in care. LPA also notified D1 of the requirement to provide a copy of this licensing report dated 07/01/2022 that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other equivalent written statement must be placed in each child's file for verification. This report was read and reviewed with D1. Notice of Site Visit (NOS) shall be posted for 30 days. Appeal rights were provided.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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Document Has Been Signed on 07/01/2022 12:02 PM - It Cannot Be Edited


Created By: Jennifer Velasco On 07/01/2022 at 07:58 AM
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 CHILDRENS PRESCHOOL CENTER
FACILITY NUMBER: 493009955

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2022
Section Cited
CCR
101223(a)(3)

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Personal Rights. Each child shall be free from corporal or unusual punishment, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. This requirement was not met as evidenced by witness statement
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Director (D1) stated she has terminated the employment of staff S1 and banned S1 from the facility. D1 also stated she will provide to LPA by 5:00 p.m. on POC due date of 07/05/2022 detailed documentatino of training provided to staff, along with
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that staff (S1) pulled the hair of child (C1) as a punishment. This constituted an immediate health and safety risk to children in care.
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staff sign-in sheet, via email at
jennifer.velasco@dss.ca.gov.

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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:Alexis Hollon
LICENSING EVALUATOR NAME:Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022


LIC809 (FAS) - (06/04)
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