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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010481
Report Date: 08/20/2024
Date Signed: 08/20/2024 04:54:23 PM

Document Has Been Signed on 08/20/2024 04:54 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:BAYNORTH LEARNING CENTER - PRESCHOOLFACILITY NUMBER:
483010481
ADMINISTRATOR/
DIRECTOR:		JACKSON, JACQUELINEFACILITY TYPE:
850
ADDRESS:2100 PENNSYLVANIA AVENUETELEPHONE:
(707) 720-5278
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 53TOTAL ENROLLED CHILDREN: 30CENSUS: 11DATE:
08/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:55 PM
MET WITH:Minister Sam MorrisTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres was present at the facility to conduct a complaint investigation. While interviewing staff, LPA observed (S1 and S4) were not on the facility roster with approved background clearance. Interviews revealed they had been present and working at the facility for over a month. LPA called the child care desk duty line to conduct a Guardian search on S1 and S4, they were not found in the system.

A civil penalty of $500 per person is being issued on the attached 809-D. 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. Exit interview conducted and report was reviewed with facility representative. LPA Hernandez Torres informed facility representative that this report dated 08/20/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Hernandez Torres informed facility representative to provide a copy of this licensing report dated 08/20/2024 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.

LPA also provided Technical assistance reviewing LIC 9163, LIC 311A in depth with the admin person regarding documents required to be on file for staff and the center.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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 08/20/2024 04:54 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 08/20/2024 at 03:02 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: BAYNORTH LEARNING CENTER - PRESCHOOL
FACILITY NUMBER: 483010481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2024
Section Cited
CCR
101170(e)(1)

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 . . .shall prior to working. . .in a licensed facility:(1) Obtain a California clearance . . . this was not met as evidence by. . .
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LPA printed out LIC 9163 for facility representative to give to S1 to go get fingerprinted ASAP. Facility representative agreed to email, mail or fax receipt and LIC 9163 after s1 has gotten fingerprinted.
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Based on roster review, guardian background check search and interviews conducted. S1 and S4 have been present and working at the facility without background clearance. This poses an 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:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
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