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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480104414
Report Date: 05/24/2024
Date Signed: 05/24/2024 02:59:03 PM

Document Has Been Signed on 05/24/2024 02:59 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:VACAVILLE CHRISTIAN EARLY EDUCATION PRESCHOOLFACILITY NUMBER:
480104414
ADMINISTRATOR/
DIRECTOR:		STEPHANIE YAMATOFACILITY TYPE:
850
ADDRESS:1117 DAVIS STREETTELEPHONE:
(707) 446-1776
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 170TOTAL ENROLLED CHILDREN: 131CENSUS: 82DATE:
05/24/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Stephanie Yamato - LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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During the course of a complaint investigation visit, Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced Case Management and met with Center Director (CD), Stephanie Yamato, to deliver a citation for a deficiency that was observed. A review of Department records revealed a staff (S1) had obtained a Department approved criminal record clearance, but, S1 was not associated to the facility license. According to CD, she made an attempt to associate S1 to the license, however; CD did not furnish evidence to verify her claims. Furthermore, on 05/21/24, the facility submitted time sheets for S1 which confirmed S1 worked at the facility for more than five days. LPA assessed an immediate civil penalty of $500 because the Licensee did not ensure S1's criminal record clearance was transferred to the facility license prior to S1 working at the facility.


The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the the , Stephanie Yamato. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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 05/24/2024 02:59 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 05/24/2024 at 01:50 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: VACAVILLE CHRISTIAN EARLY EDUCATION PRESCHOOL
FACILITY NUMBER: 480104414

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2024
Section Cited
CCR
101170(e)(2)

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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: Request a transfer of a criminal record clearance as specified in Section 101170(f).

This requirement was not met as evidenced by: Based on a review of Department records
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LPA provided S1 with required transfer documents to request a transfer. S1 completed the forms and submitted the forms to the Department to request a transfer of her clearance. Director said in the future, she plans to review Gaurdian to ensure all staff ar cleared and associated to the facility license.
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which revealed S1's criminal record clearance was not associated to the facility license. This posed/poses a potential health, safety and/or personal rights risk to the children in care.
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Director intends to produce and submit a written statement detailing how the facility would comply with CCR 101170(e)(2).

Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099

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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:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024


LIC809 (FAS) - (06/04)
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