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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233002802
Report Date: 07/16/2024
Date Signed: 07/16/2024 04:57:28 PM


Document Has Been Signed on 07/16/2024 04:57 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:GLASS BEACH - INFANT CARE CENTERFACILITY NUMBER:
233002802
ADMINISTRATOR:SHEA, MARTHAFACILITY TYPE:
830
ADDRESS:930 STEWART STREETTELEPHONE:
(707) 961-9611
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY:8CENSUS: 2DATE:
07/16/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Martha SheaTIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA), Robert Maciel made an unannounced Plan of Correction (POC) visit and met with Director, Martha Shea (S1), for the purpose of following up on outstanding POCs that were due by 03/21/2024. During the annual inspection on 02/21/2024, the facility was cited four violations which include the facility not yet having its its drinking water tested for lead contamination levels, a staff member's (S2) file being unavailable for review, present staff not possessing current mandated reporter training certificates, and the facility not possessing a complete physician's report for child 4 (C4).

On 3/21/24, S1 emailed a copy of the complete file of S2 to LPA. On 4/4/24, S1 emailed a copy of Mandated Reporter Training certificates for every staff to LPA.

During today's visit, LPA observed 2 children in care. LPA requested facility and children's records. Record review showed that the facility was tested for lead contamination on 03/30/24 and the facility did not possess C4's physician's report.

The following violations of the California Code of Regulations Title 22 were cited. Please see LIC809-D. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Martha Shea.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert MacielTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024
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 07/16/2024 04:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: GLASS BEACH - INFANT CARE CENTER
FACILITY NUMBER: 233002802

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2024
Section Cited
CCR
10122(a)

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(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:
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Director stated she would obtain a completed physician's report from C4's parents and send a copy to LPA by email at robert.maciel@dss.ca.gov
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Based on record review, child 4 (C4) was missing a physician's report which poses a potential health, safety or personal rights risk to persons in care.
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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 HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert MacielTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024
LIC809 (FAS) - (06/04)
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