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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407942
Report Date: 04/09/2024
Date Signed: 04/09/2024 12:12:59 PM

Document Has Been Signed on 04/09/2024 12:12 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:ABOVE & BEYOND PRESCHOOLFACILITY NUMBER:
485407942
ADMINISTRATOR/
DIRECTOR:
ROWLAND, PAULAFACILITY TYPE:
850
ADDRESS:126 PEABODY ROADTELEPHONE:
(707) 386-3171
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 27TOTAL ENROLLED CHILDREN: 108CENSUS: 18DATE:
04/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:12 AM
MET WITH:Paula Rowland - Center Director TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced follow up Plan of Correction (POC) visit and met with Center Director (CD), Paula Rowland, for the purpose of addressing an outstanding type B deficiency. On 03/15/24, the facility was cited for not furnishing evidence of required staff Immunization Records (IR) for S1-S2 & AD. On 03/29/24, CD submitted proof of immunity against Influenza for S1, proof of immunity against Measles, Pertussis and Influenza for S1, and evidence of immunity against Influenza for AD.

During today's visit, LPA counted 18 children in care with CD and AD, LPA did not observe any health and safety risk; and the children did not appear to be in distress. CD submitted proof of immunity against Pertussis for S1, however; CD did not furnish evidence of immunity against Measles for S1. According to CD, she thought she submitted all required documents but overlooked S1’s proof of immunity against Measles. LPA had a discussion with CD regarding the outstanding POC, and CD understood it was her responsibility to obtain required IR from staff prior to working at the facility. CD agreed to obtain evidence to show S1 took positive steps towards obtaining immunity against Measles and CD said she intends to submit the evidence to the Department by 04/10/24. LPA informed CD if she did not submit the POC as described and agreed, the facility would be assessed a civil penalty for not correcting the deficiency. LPA provided Health and Safety Code 1596.7995(a)(1), CD stated she understood the requirements and appeared to have acknowledged the Health and Safety Code.

Exit interview conducted and report was reviewed with the CD, Paula Rowland. Notice of Site Visit shall be posted for 30 days. Failure to comply with posting requirements shall result in an immediately civil penalty of $100. There were no violation(s) of Title 22 cited at this time.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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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