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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214479
Report Date: 04/10/2023
Date Signed: 04/10/2023 04:50:23 PM

Document Has Been Signed on 04/10/2023 04:50 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:SBCEO - LOMPOC CAL-SAFEFACILITY NUMBER:
426214479
ADMINISTRATOR:TRISHA CARLONEFACILITY TYPE:
850
ADDRESS:320 NORTH J STREETTELEPHONE:
(805) 742-3134
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 3DATE:
04/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Mary Miller TIME COMPLETED:
04:50 PM
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On April 10, 2023, 3:31 PM Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced 1 Year Required inspection at the Child Care Center. The purpose of the inspection was discussed with Teachers Mary Miller and Brittany Donelson, who provided a tour of the facility. The Interim Director was not present at the time of the inspection. There were 3 toddlers and 2 teachers present. Child Care Center Program Coordinator, Trisha Carlone came by in the Center.

LPAs observed the licensing required notices posted prominently in the hallway. The center has one classroom in use for child care, and one toilet and a sink. Age-appropriate toys books and furniture were available for children and the outdoor playground has age-appropriate toys and equipment. The center has water available for children inside and outside the classroom.

A sampling of children and staff records were reviewed. LPAs reviewed children's files and were found complete Teachers present have current Pediatric First Aid/CPR certificate that expires on 8/8/2024. Staff immunization records are on file including the tuberculosis clearance. Staff have taken the Mandated Report Training which will expire on 8/17/2024


Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2023
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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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: SBCEO - LOMPOC CAL-SAFE
FACILITY NUMBER: 426214479
VISIT DATE: 04/10/2023
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No deficiencies were cited during today's inspection.

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 following 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep Regulation, the frequently asked questions (FAQ) and the Safe Sleep Regulation web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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.

CCC was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Teacher Mary Miller
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC809 (FAS) - (06/04)
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