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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009064
Report Date: 05/04/2022
Date Signed: 05/04/2022 01:20:47 PM

Document Has Been Signed on 05/04/2022 01:20 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:ALANO, THERESE FCCHFACILITY NUMBER:
483009064
ADMINISTRATOR:ALANO, THERESEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 342-2142
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
05/04/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Therese Alano - LicenseeTIME COMPLETED:
01:40 PM
NARRATIVE
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Through the course of a complaint investigation visit, Licensing Program Analysts (LPAs), Melchisedeck Augustin and Sebastian Phouthavong conducted an unannounced Case Management visit due to several deficiencies that were observed at the facility. LPAs reviewed staff records (LS & S1) which revealed LS & S1's AB 1207 Mandated Reporter Training certificates were expired, as well as S1 did not have a current EMSA approved pediatric CPR/First Aid certification. LPAs had a brief discussion with S1 regarding transportation of children, and according to S1, on at least three or four occasions, S1 was alone when S1 transported a child from school to the facility at the request of the parent because the parent was unable to pick up the child from school which resulted in the facility not complying with California Code of Regulations, 102416(c)(1)(b). LPAs discussed and consulted on CCR 102416 and LS acknowledged and appeared to understand the requirements of the regulation.

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. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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 05/04/2022 01:20 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 05/04/2022 at 12:47 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: ALANO, THERESE FCCH
FACILITY NUMBER: 483009064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2022
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she
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Licensee stated she and S1 will complete the online AB 1207 Mandated Reporter training module at, mandatedreporterca.com and she would submit staff current certificates to the Department by 06/19/22 via mail, email or fax
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completed the initial mandated reporter training.

This requirement is not met as evidenced by: based on staff (LS & S1) records reviewed which revealed LS and S1's AB 1207 Mandated Reporter training certificates were expired, and this poses a potential health, safety and personal rights risk to the children in care.
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Email: [email protected]
Fax: 707-588-5099
Type B
05/25/2022
Section Cited
CCR102416(c)(1)(b)

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A licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, or when children are off-site of the facility for facility activities....
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Licensee stated she would ensure that S1 register for an EMSA approved pediatric CPR/First Aid training, complete the training, and LS would submit S1's current pediatric CPR/First Aid certification to the Department by 05/25/22 via mail, email or fax.
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This requirement is not met as evidence: based on S1's statement which confirmed on at least one occasion, S1 transported a child without a current EMSA approved pediatric CPR/First Aid certification, and this posed/poses a potential health, safety and personal rights risk to the children in care.
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Email: [email protected]
Fax: 707-588-5099
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: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022


LIC809 (FAS) - (06/04)
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