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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215575
Report Date: 07/11/2024
Date Signed: 07/11/2024 12:30:02 PM

Document Has Been Signed on 07/11/2024 12:30 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:COLES FCC AKA ADVENTURE DAY CAMPFACILITY NUMBER:
406215575
ADMINISTRATOR/
DIRECTOR:		KIMBERLY MAE COLESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 610-4961
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
07/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Kimberly ColesTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On 7/11/24, at 10:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Kimberly Coles, Licensee of the FCCH, and explained the purpose of the inspection. LPA, in the company of the
Licensee, toured the exterior and interior of the FCCH. The FCCH is a five bedroom, four bathroom, single story dwelling. The FCCH's family room (converted), living room, kitchen, dining room, bathrooms (2), guest bedrooms (2) and outdoor yards are used for child care, while the remainder of the home is excluded from child care. At the time of the inspection, LPA observed 13 children along with two Assistants (cleared and associated) providing care and supervision.

The FCCH is clean and orderly and void of hazardous items. Required forms are posted on the FCCH's family room wall. Cleaning compounds in the FCCH are secured under the sink in the kitchen, while medication in the FCCH is stored on the shelf of an elevated cabinet in the kitchen. Sharps are observed in a secure kitchen drawer. The FCCH has a fire place in the living room which is filled with household plants and decorative. The bathrooms used by children in care are in clean and sanitary operating conditions and free of toxins. LPA observed smoke and carbon monoxide detectors in the FCCH. The smoke detector was tested at 11:25 AM, while the carbon monoxide detector was tested at 11:15 AM. Both detectors are operable. The FCCH has a regulation fire extinguisher which was purchased on 7/8/24. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. Toys, furniture and play equipment observed within the FCCH are age appropriate. The home maintains working telephone services.

The outdoor yards (front, back and side) of the FCCH are all used for child care services. The yard areas are enclosed by a combination of fencing. The footing in the areas are varied. The is a storage building in the backyard which contain office supplies. The storage building is secure and inaccessible to children in care. Toys and play equipment observed in backyard area are age appropriate. LPA reminded the Licensee to replace play equipment and toys in the outdoor areas when such items begin to degrade. Additionally, LPA
(CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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: COLES FCC AKA ADVENTURE DAY CAMP
FACILITY NUMBER: 406215575
VISIT DATE: 07/11/2024
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reminded Licensee to maintain direct supervision of children in care with in the outdoor areas, given the areas scale, or when traveling off site for nature walks or the like. LPA observed no bodies of water on site.

LPA reviewed the records of children on site. The records were current, complete and possessed emergency contact information and immunization records, among other things. The Licensee's records are current and complete with pedantic CPR and First Aid certifications (EMSA approved) expiring on 7/15/25, and Mandated Reporter training certification expires on 1/9/26. The Licensee informed LPA no firearm or ammunition are stored on site. Facility records reveal the last fire drill occurred on 5/14/24. The FCCH has three dogs on site. LPA reviewed vaccination records for each of the dogs and the vaccinations are current.

The Licensee provides Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing 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, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with Licensee 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. LPA also informed Licensee 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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the
(CONT. 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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: COLES FCC AKA ADVENTURE DAY CAMP
FACILITY NUMBER: 406215575
VISIT DATE: 07/11/2024
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facility and LPA completed the RSO profile in FAS on 7/1/24.

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

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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