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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008069
Report Date: 02/08/2024
Date Signed: 02/08/2024 01:48:22 PM

Document Has Been Signed on 02/08/2024 01:48 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: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: 26CENSUS: 22DATE:
02/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Theresa SabatinoTIME COMPLETED:
02:00 PM
NARRATIVE
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On 02/08/2024 Licensing Program Analyst (LPA) Mindy Mohr conducted an unannounced Case Management visit to verify the facility has a qualified Director. Upon arrival LPA conducted a review of staff files and interviewed one staff (S1) which revealed the facility does not have a qualified Director, and have been operating without one for longer than 30 days.


Furthermore, during record review and interviews it was confirmed that Adult (A1) did not have a criminal record clearance and was providing care and supervision to children from 02/01/2024 -02/07/2024. The Licensee did not ensure A1 obtained a criminal record clearance prior to working at the facility. This is a subsequent violation within a 12 month period cited on 10/04/2023, there is a $100/ day x 7 days immediate $700 Civil Penalty being assessed today.

It was also revealed during the interview with S1 and children's record review that the facility failed to provide the Type A report dated 10/04/2023 to all currently enrolled parents/guardians and to any newly enrolled parents/guardians. Children's files were also missing a signed Acknowledgement of Receipt of Licensing Report (LIC9224).

Title 22 deficiency is being cited on the attached LIC 809D and a $700 civil penalty is being issued. Appeal Rights were provided.




(Continued on LIC809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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 02/08/2024 01:48 PM - It Cannot Be Edited


Created By: Melinda Mohr On 02/08/2024 at 12:34 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: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2024
Section Cited
CCR
101170(e)(1)

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101170(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department
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S1 stated A1 has a criminal record clearance as of 02/08/2024.
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This requirement is not met as evidenced by:
Based on record review and interviews conducted A1was working in the facility without a clearance from 02/01/2024-02/07/2024.
This poses a immediate health and safety risk to 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: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/08/2024 01:48 PM - It Cannot Be Edited


Created By: Melinda Mohr On 02/08/2024 at 12:51 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: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2024
Section Cited
HSC
1596.8595(c)(1)

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1596.8595(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation...
This requirement has not been met as evidenced by:
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S1 stated she will give all currently enrolled families a copy of the report and will have them all sign the LIC 9224 today or the next day they are in care. For newly enrolling students she will give the report and will have them sign the LIC9224 at the time of enrollment
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Based on record review children’s files, both current and newly enrolled, did not contain a signed form LIC9224 which is required after receiving a Type A citation, dated 10/04/2024.
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Type B
02/22/2024
Section Cited
HSC101215.1(b)

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101215.1(b) All child care centers shall have a director.

This requirement is not met as evidenced by:
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S1 stated she will send in all of her required paperwork to LPA by 02/22/2024 by email to: Melinda.Mohr@dss.ca.gov
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Based on interview and record review, the licensee did not comply with the section cited above as they have been operating without a Director 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:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024


LIC809 (FAS) - (06/04)
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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: NAPA VALLEY MONTESSORI LEARNING CENTER - P/S
FACILITY NUMBER: 283008069
VISIT DATE: 02/08/2024
NARRATIVE
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LPA Mohr informed S1 that this report dated 02/08/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is was immediate risk to the health, safety, or personal rights of children in care. LPA Mohr informed S1 to provide a copy of this licensing report dated 02/08/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


Exit interview conducted, and report was reviewed with facility representative Theresa Sabatino.

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: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
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