493010083-12-22-2023-01-CC-ASTR-CYS26D-20231222160658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010083
Report Date: 12/22/2023
Date Signed: 12/22/2023 04:07:07 PM

Document Has Been Signed on 12/22/2023 04:07 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	ACHIEVERS		FACILITY NUMBER:	493010083
ADMINISTRATOR:	HEATHER PETERS		FACILITY TYPE:	850
ADDRESS:	573 SUMMERFIELD ROAD		TELEPHONE:	(707) 539-6232
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 47	CENSUS: 26	DATE:	12/22/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:04 PM
MET WITH:	Heather Peters		TIME COMPLETED:	04:16 PM

NARRATIVE

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A required one year inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with facility representative, Heather Peters (D1). Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility operating hours are 7:30am-5:30pm Monday-Friday, closed the first Monday of each month at 1:00pm for staff development. The facility was toured inside and outside. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications were observed to be inaccessible to children. D1 stated there are no poisons in the facility, and none were observed during this inspection. During the tour of the facility LPA observed multiple areas of the physical plant that were not in good condition. The area above children's sink near diaper changing area had exposed dry wall, the metal strip along outside doors was separating from doors, exposing a screw on one door. Outdoor play equipment (space ship, red car, and steering wheel) had areas of deteriorating or splinted wood. There is uncontaminated drinking water available to children indoors and outdoors by use of individual water bottles. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the staff office area. LPA observed food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. Menus are posted in the entry of the school on parent board. LPA was not able to test smoke detector or carbon monoxide detector, but reviewed a report provided by D1 documenting Bay Alarms inspection report dated 09/05/23, stating that the alarms were tested and functioning. LPA observed fire extinguishers that appeared to be charged in the facility.

Continued on LIC 809-C.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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 12/22/2023 04:07 PM - It Cannot Be Edited

Created By: Amy Strother On 12/22/2023 at 03:05 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: ACHIEVERS	FACILITY NUMBER: 493010083
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239(n)

Fixtures, Furniture, Equipment and Supplies

(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, multiple areas of the physical plant were not in good condition. The area above children's sink near the diaper changing area had exposed dry wall, metal strip along outside doors was separating from doors, exposing a screw on one door. Outdoor play equipment (space ship, red car, and steering wheel) had areas of deteriorating or splinted wood. The licensee did not comply with the section cited above in maintaining the named areas above in good condition, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/19/2024
	Plan of Correction
1 2 3 4	Director stated that dry wall will ensure that the dry wall above children's sink is covered with a finishing material, metal trim on outdoor doors will be removed and replaced with new trim, all decaying or splinted wood on play equipment will be evaluated and either removed, sanded, or padded.

Type B

Section Cited

CCR

101226(e)(1)(B)

Health-Related Services

(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in stored medication for two children, C6 and C7. C6 and C7's medication did not contain it's original packaging or a label with instructions from the physician, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/19/2024
	Plan of Correction
1 2 3 4	Director stated she will communicate with the parents of C6 and C7 and require them to bring in the original prescription box with physician's label by 01/19/2024.

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:

Alexis Hollon

LICENSING EVALUATOR NAME:

Amy Strother

LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ACHIEVERS	FACILITY NUMBER: 493010083
	VISIT DATE: 12/22/2023

NARRATIVE

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There is pea gravel underneath climbing structure to absorb falls. There were no bodies of water observed on the site. D1 stated no weapons are stored on site, and none were observed.

During today's inspection, staffing ratios were being met, a total of 26 preschool children were being supervised by 3 teachers. The facility was operating within the licensed capacity and ratio requirements. At least one staff member present, possessed current CPR and First Aid certifications, D1's certificate expires 05/2025.

Five children’s records were reviewed and contained complete and current information as required. Four staff files were reviewed and contained all records as required.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA observed prescription medication stored for children C6 and C7. Although the medication was stored in a bag with the child's name and contained documentation of parents authorization to administer medication, the medication was not contained in it's original container with physician's label.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Continue on LIC809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ACHIEVERS	FACILITY NUMBER: 493010083
	VISIT DATE: 12/22/2023

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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

A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with facility representative, Heather Peters.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC809 (FAS) - (06/04)

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