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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 12:21:47 PM

Document Has Been Signed on 06/28/2024 12:21 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:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Kimberly BarrientosTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 6/28/24, Licensing Program Analysts (LPAs) Elvin Baddley and Joaquin Mendez conducted an unannounced Case Management Legal/Non-Compliance Visit/ Inspection of the abovementioned Child Care Center (CCC) to deliver an Accusation/Exclusion Action (CDSS No. 7924158005) in the matter of employee Haydn T. Sweaney. LPAs met with Assistant Director Kimberly Barrientos and explained the nature and purpose of the inspection. LPAs note 40 children are on site along with 7 teachers providing care and supervision.

The Accusation/Exclusion Action was discussed with the Assistant Director. The Accusation/Exclusion Action indicates CCLD's intent to prohibit employee Haydn T. Sweaney from licensed child care facilities. CCLD records show Sweaney began association with the CCC on 5/21/24..

A copy of this Accusation shall be provided to the parent/guardian of currently enrolled child by the next business day or immediately upon return as well as the parent/guardian of any enrolled child until the accusation is either dismissed or resolved through the Administrative Hearing or stipulated agreement. The following documentation was provided and explained:

· Accusation CDSS No. 7924158005
· Acknowledgement of Receipt of Licensing Reports (LIC 9224)

No deficiencies were cited during today's inspection. A Notice of Site Visit (LIC 9213) was issued and must remain posted for 30 days or a civil penalty of $100 may apply. Appeal Right (LIC 9058) were given to Assistant Director.

Exit interview was conducted and report was reviewed with Assistant Director 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
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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