Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008714
Report Date: 01/27/2017
Date Signed 02/01/2017 10:01:27 AM

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:LITTLE ANGELS PRESCHOOLFACILITY NUMBER:
483008714
ADMINISTRATOR:LINDA MARGARET REIDFACILITY TYPE:
850
ADDRESS:1350 AMADOR STREETTELEPHONE:
(707) 342-8815
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:12CENSUS: 6DATE:
01/27/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:LindaTIME COMPLETED:
02:45 PM
NARRATIVE
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(3) A visit was made to the facility by LPA, Araceli Canela. The facility file was reviewed prior to this visit. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Operating hours are M-F 7:30am-6:00pm, children bring their own lunch and center provides snack. During today's visit ratio and capacity were in compliance. The facility was toured inside and outside. The facility appeared clean. The items that could pose a danger to children (cleaning compounds, sharps, and medications) were inaccessible to children. Director Linda stated no poisons are stored on site and none were observed during the visit. The toys, floors, desks and other equipment appeared clean and safe. There was drinking water available/accessible to children both indoors and outdoors. The children's bathroom appeared in safe and sanitary operating condition. Containers for solid waste had a tight-fitting lid. Classroom had a working fire extinguisher and smoke detector available. The playground was completely fenced and free of hazards. The playground equipment appeared in safe condition and cushioned to absorb a fall. There were no bodies of water on the premises. Staff files, and children's files will be reviewed at a later time as files are across the playground in office and director is the only one present providing care and is unable to grab them at this time. The sign in/out procedure was reviewed; authorized representatives are signing children in/out. This facility is currently providing Incidental Medical Services (IMS) and a plan was requested. CPR and First Aid is expired.

Notice of Site Visit shall be posted for 30 days from today's visit. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-1406
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3


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: LITTLE ANGELS PRESCHOOL
FACILITY NUMBER: 483008714
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2017
Section Cited
H&S 1596.954
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Carbon monoxide detectors required; inspection

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. Today there was no carbon Monoxide available.
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I will send proof of correction to LPA Canela by 1/30/17 by fax, text picture or email.
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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) 588-5026
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-1406
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: LITTLE ANGELS PRESCHOOL
FACILITY NUMBER: 483008714
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2017
Section Cited
H&S 1597.622
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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home 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. Today director has no proof of requirement
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will send proof to LPA Canela by 2/27/17

Fax (707)588-5099
araceli.canela@dss.ca.gov
Type B
02/27/2017
Section Cited
102416(c)
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Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
Today directors CPR and 1st aid are expired
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will send proof to LPA Canela by 2/27/17

Fax (707)588-5099
araceli.canela@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: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-1406
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2017
LIC809 (FAS) - (06/04)
Page: 3 of 3