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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215266
Report Date: 06/28/2024
Date Signed: 06/28/2024 12:19:55 PM

Document Has Been Signed on 06/28/2024 12:19 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:COUNTRY COTTAGE PRESCHOOLFACILITY NUMBER:
406215266
ADMINISTRATOR/
DIRECTOR:		BRIANNA MALLORYFACILITY TYPE:
850
ADDRESS:2075 JOHNSON AVENUETELEPHONE:
(805) 235-2153
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY: 62TOTAL ENROLLED CHILDREN: 62CENSUS: 40DATE:
06/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Kimberly BarrientosTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 6/28/24, at 9:30 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Joaquin Mendez conducted an unannounced Annual/Random Inspection of the abovementioned Child Care Center (CCC). LPAs met with Kimberly Barrientos, Assistant Director of the CCC and explained the nature and purpose of the inspection. LPAs, in the company of Assistant Director, toured the interior and exterior of the CCC. The CCC operates from 7:45 AM to 5:30 PM, Monday - Friday. The preschool uses three classrooms (2 year old-3 year old Classroom, 4 year old - 5 year old Classroom and 3 year old classroom) for care. LPAs notes the 3 year olds classroom is not in use at this time. LPAs observed 40 children in care along with 7 teachers (cleared and associated) providing care and supervision. LPA notes the Assistant Director is assisting with the direct care and supervision of children on site.

LPAs observed the CCC's classrooms to be clean and orderly. The classrooms were observed to have age appropriate toys and furnishings available for children in care. Toys include auditory, visual and tactile stimulation items as well as items to enhance and the manipulative skills of children. Each classroom has a carbon monoxide detector. A carbon monoxide detector was tested at 10:18 AM and found to be operable. The bathrooms in the CCC used by children in care are in safe and sanitary operating condition. The attached kitchen was observed to be clean and free of toxins. Food and beverages capable of spoiling were stored in an operable refrigerator. The children have available drinking water both inside and outside the CCC. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers 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 note the CCC has a waiver on file for lead testing. The CCC provides morning and afternoon snacks for the children. Children bring lunch from home. LPAs observed required licensing notices and documents posted predominately at the
(CONT. 809-C Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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 3
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: COUNTRY COTTAGE PRESCHOOL
FACILITY NUMBER: 406215266
VISIT DATE: 06/28/2024
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entry of the CCC. Required forms are also posted in the CCC's interior hall way.
LPAs observed Sign In/Out forms near the entry of the CCC which contained the children's arrival and departure times as well as the signatures of authorized representatives.

LPAs observed disinfectants and cleaning compounds in elevated locations in each classroom which are beyond the reach of children in care. Assistant Director informed LPA no medication is stored on site, however when medication is present the medication is secured in the Director's office. Sharps were observed secured in each classroom.

The CCC's outdoor playground areas are enclosed by a chain linked fence and has varied footing. The fence’s entry/exit gates are secured. LPA observed age appropriate toys/play equipment in the outdoor play areas The toys/play equipment are in suitable condition and free of sharp, loose or pointed objects. The play structures in the playground areas have adequate cushioning materials to absorb falls and shade in the form of tress and building overhangs. No bodies of water were observed on site. Waste receptacles with tight fitting covers were observed throughout the CCC.

A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information and children immunization records, amongst other required licensing documents. LPA notes the CCC has no children under the age of 2 years old. Staff records were reviewed and contained documentation to support their educational experience and training certifications, amongst other required licensing documents. Assistant Director noted no firearms/weapons or ammunition are stored on the premises.

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/.



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
(CONT. 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: COUNTRY COTTAGE PRESCHOOL
FACILITY NUMBER: 406215266
VISIT DATE: 06/28/2024
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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.

LPAs discussed the safe sleep regulations with Facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Kimberly Barrientos.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
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