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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216323
Report Date: 07/15/2022
Date Signed: 09/23/2022 12:01:15 PM

Document Has Been Signed on 09/23/2022 12:01 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:NIPOMO RECREATION LITTLE BITS PRESCHOOLFACILITY NUMBER:
406216323
ADMINISTRATOR:MIRANDA AGUILARFACILITY TYPE:
830
ADDRESS:726 TEFT ST.TELEPHONE:
(805) 929-4175
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 9DATE:
07/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Miranda Aguilar and Amber TIME COMPLETED:
03:03 PM
NARRATIVE
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This is an amendment of the report dated 7/15/2022 under facility number 426216323 to reflect the correct facility number, 406216323.

On 7/15/2022 at 11:45 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management inspection regarding the self reported incident which occurred July 11, 2022. LPA asked Pre screening questions, related to COVID-19 and Site Supervisor's responses indicate there are no COVID-19 exposure on site. LPA met with Program Director Miranda Aguilar and Site Supervisor Amber Villamor. There were 5 infants, 4 toddlers and 9 staff present during the inspection

Based on the incident report, Child 1 was left on the playground during the transition from playground to the classroom. It is noted that playground is situated across the parking lot. On or about 11:00 AM when Staff 1 was going to the dumpster to throw the trash, Staff 1 observed Child # 1 alone by the bench. Based on Staff 1 recollection, Child # 1 was staring at Staff 1 and Child # 1 was not crying. Staff 1 notified the Site Supervisor of the incident. LPA interviewed all the staff present during incident, Interview revealed that prior to finding C1 in the play yard, Staff 2 went outside to check on a child's sweater and did not observe C1. Video footage was not available at the time of the inspection.

During today's inspection, deficiency was cited under Title 22 Division 12.

An immediate civil penalty of $500.00 was assessed.

Continued on LIC 809 C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
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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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: NIPOMO RECREATION LITTLE BITS PRESCHOOL
FACILITY NUMBER: 406216323
VISIT DATE: 07/15/2022
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LPA Reyes informed Site Supervisor, Amber Villamor that this report dated 7/15/2022 documents one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Reyes informed the Site Supervisor, Amber Villamor to provide a copy of this licensing report dated 7/15/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Notice of Site Visit was issued.

Exit interview was conducted and report was reviewed with Site Supervisor, Ms. Amber Villamor
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
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Document Has Been Signed on 09/23/2022 12:01 PM - It Cannot Be Edited


Created By: Gigi Reyes On 09/13/2022 at 09:40 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: NIPOMO RECREATION LITTLE BITS PRESCHOOL
FACILITY NUMBER: 406216323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2022
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Site Supervisor agreed to submit a written plan of correction to CCL no later than Monday, 7/18/2022.
Site Supervisor will re train staff on counting the children multiple times and out loud to ensure that other staff present could hear during the transition period. A Name to Face tracking of children will also be considered a s a plan of correciton.
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This requirement is not met as evidenced by: Child # 1 was left outside the play yard which was accross the parking lot for approximately 10 minutes. This poses an immediate risk to health, safety and personal rights of children in care.
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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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022


LIC809 (FAS) - (06/04)
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