<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233002800
Report Date: 07/16/2024
Date Signed: 07/16/2024 04:57:43 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 - PRESCHOOLFACILITY NUMBER:
233002800
ADMINISTRATOR/
DIRECTOR:		SHEA, MARTHAFACILITY TYPE:
850
ADDRESS:930 STEWART STREETTELEPHONE:
(707) 961-9611
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 7DATE:
07/16/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:36 PM
MET WITH:Martha SheaTIME VISIT/
INSPECTION COMPLETED:
05:12 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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 six violations which include the facility not yet having its its drinking water tested for lead contamination levels, a staff member's (S3) file being unavailable for review, present staff not possessing current mandated reporter training certificates, a staff (S1) not possessing a record of immunization against measles, pertussis, or influenza, and the facility not possessing a complete physician's report for child 5 (C5) and a signed LIC995 Child Care Center - Notification Of Parent's Rights form for child 3 (C3).

On 3/21/24, S1 emailed the LIC995 Child Care Center - Notification Of Parent's Rights form for C3 to LPA. On 4/4/24, S1 emailed a copy of Mandated Reporter Training certificates for every staff, the staff file for S3, and S1's proof of immunization against pertussis to LPA. The staff file for S3 contained all required documents except for a health screening.

During today's visit, LPA observed 7 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, the facility possessed C5's physician's report and S1's influenza declination statement. The facility does not possess proof of immunization against Measles for S1.

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.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
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)
Page: 1 of 2
Document Has Been Signed on 07/16/2024 04:57 PM - It Cannot Be Edited


Created By: Robert Maciel On 07/16/2024 at 04:12 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: GLASS BEACH - PRESCHOOL
FACILITY NUMBER: 233002800

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
HSC
1596.7995(a)(1)

1
2
3
4
5
6
7
(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:
1
2
3
4
5
6
7
Director stated she would obtain the immunization record for measles and send a copy to LPA by email at robert.maciel@dss.ca.gov
8
9
10
11
12
13
14
Based on record review, staff 1 (S1) did not possess a record of immunization against measles which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Robert Maciel
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)
Page: 2 of 2