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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213788
Report Date: 11/20/2024
Date Signed: 11/20/2024 11:20:25 AM

Document Has Been Signed on 11/20/2024 11:20 AM - 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 BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAL POLY PRESCHOOL LABFACILITY NUMBER:
406213788
ADMINISTRATOR/
DIRECTOR:		CLARKSON, PATRICIAFACILITY TYPE:
850
ADDRESS:1 GRAND AVENUETELEPHONE:
(805) 756-2220
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93407
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 20DATE:
11/20/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Patricia ClarksonTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 11/20/24, at 9:05 AM , Licensing Program Analysts (LPAs) Shane Loftus and Elvin Baddley conducted an unannounced Required Inspection of the above-mentioned Child Care Center (CCC). LPAs met with Patricia Clarkson, Director of the CCC and explained the purpose of the inspection. LPAs, in the company of Director, toured the interior and exterior of the CCC. The center operates from 8:30 AM to 4:30 PM, Monday - Friday. The preschool uses one room for child care services, along with upper and lower outdoor activity areas. LPAs observed 20 children on site during the inspection along with 4 (cleared and associated) teachers providing care and supervision.

The room used for child care is clean and organized. The room has age-appropriate toys and furnishings available for children. The CCC has carbon monoxide detector in the room which was tested at 10:15 AM and found to be operable. The restroom used for care is in safe and sanitary operating condition. Parents of children in care provide snacks and lunches. There is available drinking water for children both inside the classroom and outside in the play area.

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

Disinfectants, cleaning solutions, and medications are stored in locked cabinets in the office of the CCC. Sharps are stored in an elevated cabinet in the kitchen area of the CCC. Each location is inaccessible to children in care.

Continued on 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAL POLY PRESCHOOL LAB
FACILITY NUMBER: 406213788
VISIT DATE: 11/20/2024
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The CCC's outdoor playground areas are enclosed by wrought iron and concrete fencing. The fences' entry/exit gates are secured. LPAs observed age-appropriate toys and play equipment in the play areas. LPAs also observed numerous sheds in the outdoor activity areas which were secured by lock and contained CCC supplies. The toys and play equipment in the outdoor areas are in suitable condition and free of sharp, loose, or pointed objects.

The play structures in the playground areas have cushioning materials to absorb falls and an abundance of shade created by trees and building overhangs. No bodies of water were observed on site. Waste receptacles with tight fitting covers were observed throughout the CCC. LPAs reviewed posted menus along with licensing required notices and documents posted predominately in the CCC. LPAs reviewed the facility's Sign in Sign Out forms upon arrival at the CCC. LPAs noted the arrival times of children in care and as well as notations from authorized representatives/parents on the forms.



A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well as immunization records. Staff records were reviewed and contained pediatric CPR and First Aid certifications as well as Mandated Report certifications. Director informed LPAs no firearms or ammunition are stored on the premises.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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/

Director 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.

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. Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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 BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAL POLY PRESCHOOL LAB
FACILITY NUMBER: 406213788
VISIT DATE: 11/20/2024
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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.

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.

A notice of site visit was given and must remain posted for 30 days. No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with Director, Patricia Clarkson.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
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