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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215575
Report Date: 07/30/2025
Date Signed: 07/30/2025 01:18:57 PM

Document Has Been Signed on 07/30/2025 01:18 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
SANTA BARBARA CC RO, 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: 11DATE:
07/30/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Kimberly ColesTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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On 7/30/25, at 9:20 AM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced annual random inspection visit of the abovementioned Family Child Care Home (FCCH). LPA met with Kimberly Coles, Licensee of the FCCH, and explained the nature and purpose of the inspection. The LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The home is a 5 bedroom and 4 bathroom single story home. The areas that are accessible for day care children are as follows: family room (main day care room), living room, dining room, kitchen, two bathrooms, two guest bedrooms, and backyard. The remainder of the home is excluded from childcare services. At the time of the inspection, LPA observed 11 day care children present, 1 of whom was an infant. LPA also observed the Licensee's husband (assistant) present on site at the time of the inspection (cleared and associated) and three other assistants (two of whom were cleared and associated). Importantly to note, an assistant, one of the Licensee's adult daughters, left the day care with a child of her own during the inspection which left the amount of children at 10. Towards the latter part of the inspection, LPA observed an additional biological child (underage) of the Licensee arrive at the FCCH.

LPA observed the FCCH to be clean and orderly. The bathrooms, utilized for childcare, are clean and free of toxins. LPA observed sharps stored on an elevated shelf in the kitchen. Family medication is stored in an elevated cabinet in the kitchen. No children currently require medication. Primary cleaning solutions are stored in the laundry room and in the kitchen beneath the sink in a locked cabinet.

LPA observed age-appropriate toys, furnishings, and equipment throughout the interior of the FCCH. In the main day care room, LPA observed a number of storage compartments each of which contained items related to the day care. In the living room, LPA observed a fireplace that was free of any wood or objects that could be hazardous to children in care. Licensee informed LPA that the fireplace does not work. Licensee informed (CONT. 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: COLES FCC AKA ADVENTURE DAY CAMP
FACILITY NUMBER: 406215575
VISIT DATE: 07/30/2025
NARRATIVE
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LPA that there are nine cats and two dogs present on site. Licensee informed LPA that the animal's vaccinations are to up to date. Licensee informed LPA that the animals have periodic interactions with children in care.

LPA observed relevant licensing forms and documents posted prominently in the day care room. LPA observed smoke and carbon monoxide detectors within the household. The smoke detector was tested at 11:09 AM and the carbon monoxide detector was tested at 11:12 AM. Each were found to be operational. LPA observed a regulation fire extinguisher in the FCCH which was last purchased on 7/30/25. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the FCCH's fire/disaster drill log. The most recent disaster drill occurred on 3/8/25. LPA reminded the Licensee that disaster drills must be conducted every six months per Department regulations.

As aforementioned, the backyard is accessible to children in care. This area is fully enclosed by a variety of fencing. The fence’s entry and exit gates are secure. The footing of the backyard area is made up of concrete pavement, natural grass, dirt, sand, and wood chips. Like the interior of the FCCH, childcare toys, structures, and play equipment observed in the outdoor area are age appropriate and are in satisfactory condition. In the backyard, shade is afforded by a number of umbrellas and trees throughout the area. LPA also observed a couple of mesh-enclosed trampolines on site. LPA observed a ladder that gives access to the trampoline away from the area. Licensee informed LPA the trampolines are not used during day care hours. LPA observed no bodies of water on site and confirmed that this was the case with the Licensee. LPA reminded the Licensee of the importance of direct supervision over children in care and to conduct inspections of outdoor area prior to letting children outside.

LPA reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records, among other relevant licensing documents and forms. The Licensee's records were also reviewed. LPA found that the Licensee completed their CPR/First Aid Training (EMSA approved) on 7/15/23 and their Mandated Reporter Training on 1/9/24. Licensee was reminded to renew certifications and training prior to expirations. The Licensee informed LPA that there are no firearms or ammunition that are stored on site.

The Licensee does not currently provide Incidental Medical Services (IMS) or administer medication to children in care. 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 (CONT. 809-C, Page 3)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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: COLES FCC AKA ADVENTURE DAY CAMP
FACILITY NUMBER: 406215575
VISIT DATE: 07/30/2025
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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 Family Child Care Homes 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 the 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 today's visit, one Type A citation was issued under Title 22 of the California Code of Regulations and Health and Safety Codes (see LIC 809-D). Upon receipt of this report, the Licensee shall post and provide copies of this licensing report to parents and guardian of children in care at the facility and to parent and guardians of children newly enrolled at the facility during the next 12 months. Licensee must provide the Acknowledgement of Receipt of Licensing Reports (LIC 9224) for each child in care and have each parent sign the form that they have received a copy of today's report.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility when the LPA completed an RSO profile in FAS on 7/30/25.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were also given and signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee, Kimberly Coles.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/30/2025 01:18 PM - It Cannot Be Edited


Created By: Matthew Sapien On 07/30/2025 at 11:50 AM
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: COLES FCC AKA ADVENTURE DAY CAMP
FACILITY NUMBER: 406215575

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2025
Plan of Correction
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The Licensee must submit a copy of the live scan form (LIC 9163) to the Department (matthew.sapien@dss.ca.gov) by 8/4/25 before the close of business day (5:00 PM) and the individual cannot be on the premises until the fingerprints are cleared. Licensee must also submit a written plan of correction on how instances of the like will be avoided moving forward.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Matthew Sapien
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2025


LIC809 (FAS) - (06/04)
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