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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215833
Report Date: 07/05/2023
Date Signed: 07/05/2023 11:44:38 AM

Document Has Been Signed on 07/05/2023 11:44 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:VILLAGE PRESCHOOLFACILITY NUMBER:
406215833
ADMINISTRATOR:KAMBER DOUCETTEFACILITY TYPE:
850
ADDRESS:205 SHORT STREETTELEPHONE:
(805) 474-9208
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 26DATE:
07/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kamber DoucetteTIME COMPLETED:
12:00 PM
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On 7/5/23, at 9:30 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required inspection of the abovementioned Child Care Center (CCC). LPA met with Kamber Doucette, Director of the CCC and explained the purpose of the inspection. LPA toured the interior and exterior of the CCC. The CCC operates from 7:00 AM to 5:30 PM, Monday - Friday. The CCC hours of operation are adjusted to 7:30 AM to 5:30 PM Monday - Friday in the Summer. The CCC uses five classrooms for care. During the inspection, LPA observed 26 children in care along with five staff members (cleared and associated).

Required licensing forms and documentation is observed posted on the wall of the CCC near the entry door. The classrooms (Play Room #1, Play Room #2. Pre K Room, Early Years Room and the MUD Room) of the CCC were clean and organized. The classrooms have age appropriate toys and furnishings available for children. The CCC has carbon monoxide detectors affixed to the classroom's walls. A carbon monoxide detector was tested at 9:57 AM and found to be operable. The CCC bathrooms, which contain two toilets and two sink, are in safe and sanitary operating condition. Disinfectants and cleaning solutions in the CCC are stored in the staff restroom which is inaccessible to children in care. The Director noted the CCC currently has no medication on site. The Director stated when medication is on site the medication is stored in a room commonly referred to as the "shed" which is secure and inaccessible to children in care.

The CCC provides snacks for the children. Children in care bring lunches from their homes. A CCC's menu is posted on a classroom wall near licensing required notices. Children have available water inside the CCC and outside in the activity area. LPA notes the CCC had it water sources tested for lead containment levels. Readings were determined to be acceptable. The CCC's Sign In/Out documentation is stored electronically. LPA reviewed entries and found entries contained the arrival and departure times of children as well as notations from the child's authorized representatives.
(CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2023
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 2
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: VILLAGE PRESCHOOL
FACILITY NUMBER: 406215833
VISIT DATE: 07/05/2023
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The CCC’s outdoor play area is enclosed by wooden fencing and footing in the area is varied. LPA observed age appropriate toys/play equipment in the play area. The toys/play equipment are free of sharp, loose or pointed objects. The play structures in the playground areas have adequate cushioning materials to absorb falls and an abundance of shade created by large trees and a tented area. Director is reminded to replace toys/play equipment when such degrades and is not in good repair. No bodies of water are 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 immunization records, amongst other required licensing documents. Staff records were reviewed and contained documentation to support qualifications and Mandated Report certifications amongst other required licensing documents. Director informed LPA 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-carecenters/.

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 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.

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.

Director confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Exit interview conducted and report was reviewed with the Facility representative Kamber Doucette. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC809 (FAS) - (06/04)
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