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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216323
Report Date: 12/15/2022
Date Signed: 12/15/2022 01:16:25 PM

Document Has Been Signed on 12/15/2022 01:16 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: 13DATE:
12/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Miranda Aguilar/Amber VillamorTIME COMPLETED:
01:15 PM
NARRATIVE
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On 12/15/2022 at 11:45 AM, Licensing Program Analyst Gigi Reyes conducted an unannounced Case Management Inspection and met with Child Care Center (CCC) Site Director, Amber Villamor . LPA asked pre-screening questions related to COVID-19 and Director's responses indicate there are no exposure on site at the time of the inspection. Program Director Miranda Aguilar came in 20 minutes later. LPA observed 5 infants and 8 toddlers and 6 staff.

On 11/4/2022, CCC Program Director self reported an incident that occurred on 10/10/2022. Based on the unusual incident report, Staff 1 came back from lunch and reported to CCC intoxicated, Staff 1 supervised children while under the influence until the children were picked up at the end of the day. Director stated she was not notified of the said incident not until October 25, 2022 by a former CCC staff whom Staff 1 disclosed the incident. On the same day, (10/25/2022) Staff 1 approached Director and admitted that the incident was true.

On 11/2/2022, Staff 1 was placed on administrative leave without pay pending an investigation. After the investigation of CCC management, on the same day, Staff 1 employment with above CCC was terminated in violation of the company policy.

On the other hand, CCC failed to report the incident to the department in a timely manner as required by regulation. Incident was reported to Community Care Licensing Division 9 days after Director was made aware of the said incident. Director stated, she conducted and internal investigation prior to notifying the department to obtain an accurate report.

During today's inspection deficiency was cited under Title 22 Division 12. Appeal Righs were given and explained.
LPA reviewed and conducted exit interview with Program Director Miranda Aguilar
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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
Document Has Been Signed on 12/15/2022 01:16 PM - It Cannot Be Edited


Created By: Gigi Reyes On 12/15/2022 at 08:36 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: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2022
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C)
d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day
(C) Any unusual incident...
This requirment is not met as evidenced by:
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The CCC Program Director agreed to submit a written plan of correction to ensure that any incidents that occur at the CCC will be reported within the Department's next working day. POC shall be submitted no later than 12/15/2022.
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Based on the self reported incident, CCC failed to report upon having knowledge of Staff 1 reporting for work while intoxicated. Program Director was notified 10/10/22 and reported it to CCL not until 11/4/2022. Director stated, CCC did an internal investigation prior to reporting. This poses a potential risk to health and safety of childen 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: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022


LIC809 (FAS) - (06/04)
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