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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008069
Report Date: 08/30/2023
Date Signed: 09/20/2023 10:08:04 AM

Document Has Been Signed on 09/20/2023 10:08 AM - 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:NAPA VALLEY MONTESSORI LEARNING CENTER - P/SFACILITY NUMBER:
283008069
ADMINISTRATOR:SMITH, TERESITAFACILITY TYPE:
850
ADDRESS:120W AMERICAN CANYON ROAD M 11TELEPHONE:
(707) 853-9580
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY: 37TOTAL ENROLLED CHILDREN: 37CENSUS: 17DATE:
08/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Todd PetersonTIME COMPLETED:
04:20 PM
NARRATIVE
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During the course of a complaint investigation, additional deficiencies were identified involving reporting requirements and personal rights violations. Based on interviews conducted with staff, children, and parents from 06/05/23 through 08/02/23, it was determined that multiple injuries had occurred at the facility during the last six months, including three that required medical attention. According to record review, it was confirmed that the facility had not filed an Unusual Incident Report during that time period as required by regulation.

In addition, multiple interviews indicated that staff talk inappropriately to children, specifically that S1 spoke to children in a rude, loud way and in an aggressive manner. Also, while at the facility on 06/15/23, LPA observed S1 stating in a raised, stern voice “I told you, I told you, see what happens when you don’t listen” in which D1 acknowledged and stated that she would talk to the staff. Furthermore, four adult and two children interviews indicated that staff (S1, D1) were loud and yell at or in front of children.



This is an amended report.

The following violation of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

Exit interview conducted, and report was reviewed with facility representative Todd Peterson.


A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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 08/30/2023 04:11 PM - It Cannot Be Edited


Created By: Melinda Mohr On 08/30/2023 at 02:09 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: NAPA VALLEY MONTESSORI LEARNING CENTER - P/S
FACILITY NUMBER: 283008069

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2023
Section Cited
CCR
101212(d)

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101212(d)… during the operation of the childcare center of any of the events… a report shall be made to the Department by telephone or fax within the next working day and during its normal business hours. In addition, a written report containing the information … shall be submitted to the Department within seven days following the occurrence of such event.
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We will report all incidents to CCLD, and will call the OD line if we have any questions in regards to reporting.
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This requirement is not met as evidenced by:
Based on interviews and facility record review, the center has not notified and submitted any Unusual Incident Report’s to CCL in the past six months when incidents did in fact occur. This poses a potential Health and Safety risk to children in care.
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Type B
09/29/2023
Section Cited
CCR101223(a)(1)

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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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View Video: Taking care of ourselves: https://www.ecmhc.org/documents/TakingCare_ProviderBk_final.pdf
“Tell Me What to Do Instead!” Communication is Key Handout (copy provided)
Once training has been completed by 09/29/23, submit a signed and dated statement including the names of the staff that have been trained on Self-Care and Communication concepts. Melinda.mohr@dss.ca.gov
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Based on interviews conducted and observations evidence confirmed D1 and S1 have yelled at day care child(ren) in care on more than one occasion, which poses a potential personal rights risk to the children 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:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023


LIC809 (FAS) - (06/04)
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