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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010356
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:20:01 PM

Document Has Been Signed on 09/08/2023 01:20 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:SOUTH COAST DAY CAREFACILITY NUMBER:
233010356
ADMINISTRATOR:KRISTIN YAGERFACILITY TYPE:
850
ADDRESS:40 SCHOOL STREETTELEPHONE:
(818) 219-7478
CITY:POINT ARENASTATE: CAZIP CODE:
95468
CAPACITY: 16TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Kristin YagerTIME COMPLETED:
01:35 PM
NARRATIVE
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On 9/8/23 Licensing Program Analyst (LPA) Robert Maciel conducted a case management visit for the purpose of delivering a citation due to observation of a written statement which revealed that Director 1 threatened Child 1 and Child 2 with taking a picture of them while they were not fully clothed and sending it to their parents as a way to coerce them into putting on their clothes.

The following deficiencies of the California Title 22 Code of Regulations was cited. Please see LIC 809-D. Appeal rights were provided. Exit interview was conducted with Administrator, Kristin Yager.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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 09/21/2023 10:09 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/20/2023 10:00 AM


Created By: Robert Maciel On 09/08/2023 at 12:48 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SOUTH COAST DAY CARE
FACILITY NUMBER: 233010356

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
101223(a)(1)

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The Licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons

This requirement is not met as evidenced by:
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Administrator stated that she started using a behaviour log with children to track difficult behaviour to keep parents informed along with parent meetings to help mitigate future behavioural issues.
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Based on interview and record review, the director threatened to photograph a child as a means to coerce them 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 Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023


LIC809 (FAS) - (06/04)
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