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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210198
Report Date: 06/06/2023
Date Signed: 06/06/2023 12:25:46 PM

Document Has Been Signed on 06/06/2023 12:25 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:ISLA VISTA CHILDREN'S CENTERFACILITY NUMBER:
426210198
ADMINISTRATOR:SERINEH VARTANIFACILITY TYPE:
850
ADDRESS:6842 PHELPS RD.TELEPHONE:
(805) 968-0488
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 53DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Serineh VartaniTIME COMPLETED:
12:26 PM
NARRATIVE
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On June 6th, 2023, at 8:57AM Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with Director Serineh Vartani and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. The facility operates Monday through Friday 8:00AM-5:00PM, including summer season. At the time of the inspection there were fifty-three (53) children and eighteen (18) staff present. This is a combined facility with an infant program.

LPA observed required licensing documents mounted on the wall at the entrance of the facility with menu. Facility uses CareConnect App for the purposes of signing in and out. LPA observed roster to be current. The facility is currently utilizing five (5) classrooms for care and supervision. All of the classrooms have ample ventilation, age-appropriate toys, and furniture readily accessible for children in care. LPA observed a variety of daily activities to meet the needs of children including rest and play. Children nap on cots and their individual bedding is stored separately. Children bring their own water bottles and facility also provides filter water for use. LPA observed all cleaning compounds, disinfectants, sharps, combustibles, and tools to be elevated and inaccessible to children. LPA observed the facility has sufficient number of restrooms and sinks available for the children, which were functioning and clean at the time of the inspection. Facility provides morning breakfast, lunch, and snack for children and LPA observed kitchen to be clean, free of rodents, and appliances in working order. Fire extinguisher was last serviced on 8/30/2022. Last emergency drill was conducted on 12/13/2022. LPA advised director emergency drills are to be conducted and documented every six months. Per director, no firearms or ammunition are present on property.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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Document Has Been Signed on 06/06/2023 12:25 PM - It Cannot Be Edited


Created By: Maryrose Breault On 06/06/2023 at 12:06 PM
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: ISLA VISTA CHILDREN'S CENTER
FACILITY NUMBER: 426210198

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and director statement, the licensee did not comply with the section cited above in two (2) counts of one (1) staff member which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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Director to provide Health Screening Report and result of TB test for staff member to LPA via email at: maryrose.breault@dss.ca.gov by 6/30/2023.
Type B
Section Cited
CCR
101217(a)(6)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (6) Documentation of the educational background, training and/or experience specified in this chapter.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and director statement, the licensee did not comply with the section cited above in one count which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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Director to provide a request for exemption for staff member to LPA via email at: maryrose.breault@dss.ca.gov by 6/30/2023.
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:Ana Tolentino
LICENSING EVALUATOR NAME:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023


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: ISLA VISTA CHILDREN'S CENTER
FACILITY NUMBER: 426210198
VISIT DATE: 06/06/2023
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LPA observed the outdoor area play area to have ample amount of space for children to play with appropriate toys and equipment. LPA observed ample shade, soft padding, and sandbox free of debris. No bodies of water are present.

Incidental Medical Services are currently being provided at this time. LPA observed one elevated, locked medical box with one (1) inhaler, labeled with child’s name, and regulatory paperwork present. LPA advised director to check periodically for any expired medication and to alert parent(s).

LPA reviewed a sampling of children and staff records. Staff files were observed to be current. LPA reviewed SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Teachers has Pediatric First Aid/CPR certificate which expires 3/5/2025 and AB 1207 Mandated Reporter Training certificates expires 2/1/2025.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation interpretations and procedures for Child Care Centers sections 101173 and 101226. When any IMS is provided, an updated plan of operation that includes IMS must be submitted to the Department. the follow information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA information line at (800) 514-0301 (voice) / (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

Type B deficiency has been cited.


Technical assistance has been provided.

Exit interview conducted, report reviewed, and copy and appeal rights provided to Director.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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