<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406210272
Report Date: 04/19/2022
Date Signed: 04/19/2022 05:10:52 PM

Document Has Been Signed on 04/19/2022 05:10 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:NIPOMO RECREATION - LITTLE BITS PRESCHOOLFACILITY NUMBER:
406210272
ADMINISTRATOR:MIRANDA AGUILARFACILITY TYPE:
850
ADDRESS:255 POMEROYTELEPHONE:
(805) 929-4175
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 19DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Miranda AguilarTIME COMPLETED:
05:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On April 19, 2022, at 2:00 PM Licensing Program Analyst (LPAs) Gigi Reyes conducted an unannounced One (1) Year Required inspection and met with facility Program Director, Miranda Aguilar. LPA explained the purpose of the inspection. LPA asked pre screening questions related to COVID 19 Director's response indicate there are no COVID 19 exposure on site. There were 19 children napping, 2 fully qualified staff and 2 staff assistants present during the inspection.

LPA in the company of Program Director toured the Center inside and outside. Licensing required forms are posted by the entrance door of the Child Care Center (CCC). The facility is currently using two (2) classroom for care. There are 3 toilets and 5 sinks readily available for children. CCC has age appropriate games, activities, and furniture available for children in care. LPA observed and reviewed the posted snack menu. The outdoor playground has age appropriate toys and equipment. Water jug provides drinking water inside and outside the classrooms.

Center uses electronic sign-in/out logs at the entrance of the facility. A sampling of children and staff records were reviewed. Teachers present have current Pediatric First Aid/CPR certificates that expire on 1/15/2024. Teachers present have current AB 1207 Mandated Reporter Training certificates that expire on 10/30/2022. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Staff # 2's file is not available for review during the inspection. Director presented Staff 2's immunization on line, but there was no LIC 503 Health Screening and Tuberculosis clearance. Staff 2 and Staff 6 do not have the educational qualification on file. Facility is following current Covid-19 guidelines.

During today's inspection, deficiencies were cited under Title 22 Division 12, Technical Assisance and Technical Violations were provided and issued.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: NIPOMO RECREATION - LITTLE BITS PRESCHOOL
FACILITY NUMBER: 406210272
VISIT DATE: 04/19/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Program Director, Miranda Aguilar.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 04/19/2022 05:10 PM - It Cannot Be Edited


Created By: Gigi Reyes On 04/19/2022 at 04:37 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NIPOMO RECREATION - LITTLE BITS PRESCHOOL
FACILITY NUMBER: 406210272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the CCC did not comply with the section cited above, Staff 2 does not have Tuberculosis clearance on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Director agreed to submit plan of correction no later thatn 4/29/2022
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on review, the CCC did not comply with the section cited above, Staff 2 does not have LIC 503 Health Screening on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Director agreed to submit Staff 2's LIC 503 no later than 4/29/2022
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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/19/2022 05:10 PM - It Cannot Be Edited


Created By: Gigi Reyes On 04/19/2022 at 04:37 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NIPOMO RECREATION - LITTLE BITS PRESCHOOL
FACILITY NUMBER: 406210272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on review, the CCC did not comply with the section cited above, Staff 2's file was not available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Director agreed to submit plan of correction no later than 4/19/2022.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022


LIC809 (FAS) - (06/04)
Page: 4 of 4