Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125406576
Report Date: 02/05/2016
Date Signed: 02/05/2016 12:14:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:GREAT BEGINNINGS PRESCHOOLFACILITY NUMBER:
125406576
ADMINISTRATOR:JOHNSON, KARENFACILITY TYPE:
850
ADDRESS:609 SUMMER STTELEPHONE:
(707) 725-9136
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY:30CENSUS: 6DATE:
02/05/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Tara ChownTIME COMPLETED:
12:31 PM
NARRATIVE
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(1) LPA DeAnna Sanders conducted a random annual visit to this facility today. The facility was toured and records were reviewed. There are no fire arms on site per the Substitute Director and none were observed by the LPA. No water hazards are present. There is locking storage for poisons. It is unclear if the device on the wall is a carbon monoxide alarm. Please provide the LPA with proof the device is a carbon monoxide alarm. The Licensee is working on an Incidental Medical Services plan and understands that no IMS may be conducted without a completed plan on file. The furnishings are in good condition with no sharp parts observed. The playground is fenced and in good condition. Heaters are screened. The bathrooms are clean, stocked and operational. The floors are clean and safe. The trash is covered. Children have individual water bottles for inside and out. All surfaces appear non-toxic. There are screens on windows. The LPA was allowed to enter and inspect the facility.
One person has current EMSA pediatric first aid and cpr. The parents are signing in and out - please make sure they all include the time of day. The children had health screenings on file. One staff did not have a tb test or health screening on file. Notice of site visit needs to be posted for 30 days. Citations on page 2.
SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5034
LICENSING EVALUATOR NAME: Deanna SandersTELEPHONE: (707) 826-9961
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2016
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: GREAT BEGINNINGS PRESCHOOL
FACILITY NUMBER: 125406576
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/05/2016
Section Cited
101216(g)(2)
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Personnel Requirements. All personnel including the licensee shall have a health-screening report, including specified information, signed by the person who performed it. One staff person did not have a health screening or TB test on file and has worked more than 7 days.
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Provide the LPA with proof of a health scrrening and TB test by the due date.
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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: Linda WalkerTELEPHONE: (707) 588-5034
LICENSING EVALUATOR NAME: Deanna SandersTELEPHONE: (707) 826-9961
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2016
LIC809 (FAS) - (06/04)
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