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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010450
Report Date: 12/19/2024
Date Signed: 12/19/2024 05:45:29 PM

Document Has Been Signed on 12/19/2024 05:45 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:JEWISH COMMUNITY CENTER SOCO PRESCHOOLFACILITY NUMBER:
493010450
ADMINISTRATOR/
DIRECTOR:
WELTON, SARAHFACILITY TYPE:
850
ADDRESS:3421 BONITA VISTA LANETELEPHONE:
(707) 528-4222
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 24TOTAL ENROLLED CHILDREN: 18CENSUS: 13DATE:
12/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Sarah WeltonTIME VISIT/
INSPECTION COMPLETED:
06:05 PM
NARRATIVE
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An Annual/Random inspection was made to the facility by Licensing Program Analysts (LPAs), Amy Strother and Jaelyn Agbayani. LPAs met with facility representative, Sarah Welton (D1). LPAs reviewed Guardian Employee Roster. One staff, S1 was not listed as having an associated criminal record clearance of file. Staff 1 (S1) did have evidence of a completed LiveScan fingerprint form LIC9163 on file and a letter of clearance specifically from DOJ Applicant Fingerprint Response. LPA Strother called the CCLD Santa Rosa Regional Office. Office staff confirmed that S1 had an "incomplete application" and was not currently associated to a facility. Although S1 did previously have an eligible clearance, S1 had been separated from all facilities. S1's clearance was no longer transferable.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The facility’s operating hours are Monday through Friday, 8:00am – 5:30pm. 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 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. LPAs 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 individual water bottles, cups are avaiable when needed. The children's bathroom is in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the office. LPAs observed food prep areas are clean. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids.

Continued on LIC 809-C

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/19/2024 05:45 PM - It Cannot Be Edited


Created By: Amy Strother On 12/19/2024 at 04:48 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: JEWISH COMMUNITY CENTER SOCO PRESCHOOL

FACILITY NUMBER: 493010450

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 12/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101217(a)(14)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (14) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 101170(e).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above.S1 did not have a criminal record clearance associated to the facility on file which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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D1 sent S1 home, providing S1 with a LiveScan form LIC9163 to go be fingerprinted. D1 stated S1 will not return to work until she has confirmed with the Santa Rosa Regional office that S1 has an eligible clearance associated to the facility. D1 will submit a written procedure for ensuring newly hired staff have eligible clearances associated prior to their first day of employment to LPA Strother's email: amy.strother@dss.ca.gov
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:Megan Aviles
LICENSING EVALUATOR NAME:Amy Strother
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2024


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Document Has Been Signed on 12/19/2024 05:45 PM - It Cannot Be Edited


Created By: Amy Strother On 12/19/2024 at 04:48 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: JEWISH COMMUNITY CENTER SOCO PRESCHOOL

FACILITY NUMBER: 493010450

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 12/19/2024

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
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Based on interview and record review, the licensee did not comply with the section cited above in 3 out of 5 staff files. Staff, S1, S3 & S4 did not have proof of immunity to Pertussis. S3 & S4 did not have proof of immunity to Measles, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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D1 will require all staff that are missing immunizations to provide proof of immunity and submit proof to LPA Strother by 01/17/25. D1 stated that she plans to require proof of immunity to Measles, Pertussis and Influenza or statement declining influenza prior to staff's first day.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 3 out of 5 staff files. Staff, S1, S2 and S4 did not have health screening available for review. S4 did not have a TB clearance on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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D1 stated that she will require S1, S2 and S4 to obtain a health screening and S4 a TB clearance, submitting proof to LPA Strother's email by 01/17/25. 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:Megan Aviles
LICENSING EVALUATOR NAME:Amy Strother
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2024


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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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: JEWISH COMMUNITY CENTER SOCO PRESCHOOL
FACILITY NUMBER: 493010450
VISIT DATE: 12/19/2024
NARRATIVE
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Menus are posted at the entrance of the school. LPAs observed a working smoke detector, carbon monoxide detector and a fire extinguisher that appeared fully charged, in the facility. LPAs observed the playground equipment and surface areas were in safe condition. There were no bodies of water observed on the site. D1 stated no weapons are stored on site, and none were observed.

During today's inspection, staffing ratios were being met, a total of 13 preschool children were being supervised by 4 teachers. 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, D1’s certificate expires 07/2025.

Five children’s records were reviewed and contained complete and current information as required. Five staff files were reviewed. 3 out of 5 staff did not have proof of required immunizations on file. Staff, S1, S3 & S4 did not have proof of immunity to Pertussis. S3 & S4 did not have proof of immunity to Measles. S4 did not have a TB clearance on file. Three out of 5 staff (S1, S2 and S4) did not have evidence of a Health Screening on file.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Continued on LIC 809-C

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: JEWISH COMMUNITY CENTER SOCO PRESCHOOL
FACILITY NUMBER: 493010450
VISIT DATE: 12/19/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Sarah Welton.

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

LPA Strother informed facility representative, Sarah Welton that this report dated 12/19/24 document(s) one Type A citation. Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Strother informed the facility representative to provide a copy of this licensing report dated 12/19/24 that documents any Type A citation(s) 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 written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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