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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215277
Report Date: 09/21/2021
Date Signed: 09/21/2021 09:00:46 PM

Document Has Been Signed on 09/21/2021 09:00 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:STUART C.GILDRED-LOS OLIVOS ELEMENTARY ENRICHMENTFACILITY NUMBER:
426215277
ADMINISTRATOR:KAYCE BUNDERSONFACILITY TYPE:
840
ADDRESS:2540 ALAMO PINTADO AVENUETELEPHONE:
(805) 686-2037
CITY:LOS OLIVOSSTATE: CAZIP CODE:
93441
CAPACITY: 21TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
09/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Liliana FloresTIME COMPLETED:
04:55 PM
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On September 21, 2021 at 3:15 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual required inspection of the above mentioned Child Care Center (CCC). Prior to inspection, LPA asked pre screening questions related to COVID 19, Teacher-in-charge Lilliana Flores' responses indicate there was no COVID exposure on site. LPA met with Liliana Flores and Ashley Warwick. LPA explained the nature of the inspection. Site Supervisor Kristine Parra came in around 3:45 PM.

During the inspection, the following was observed, There were 14 school age children present. The CCC utilizes room 403, classroom has carbon monoxide detector and was functioning at the time of visit. Licensing required forms and menu are posted in prominent location. Water pitcher supplies drinking water in the classroom. Drinking water is provided in the outdoor play area by a water fountain.

A sampling of staff and children records were reviewed. Children's records are electronically compiled. The children’s records were complete and found to contain emergency contact information. A review of staff records on 9/15/2021 indicates that all facility staff have criminal record clearance. Center staff has current pediatric cpr which expires on 6/5/2023. Electronic sign in and sign out record meets the regulation requirements. AB 1207 Mandated Reporter Training was taken on 8/29/2021
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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: STUART C.GILDRED-LOS OLIVOS ELEMENTARY ENRICHMENT
FACILITY NUMBER: 426215277
VISIT DATE: 09/21/2021
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Director noted no firearm or ammunition is stored on site.

Incidental Medical Services (IMS) policy was discussed. 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.htmhttp://www.ada.gov/childqanda.htm

In areas evaluated, there was no deficiency cited under Title 22 Division 12 and Health and Safety Code.


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 BE ASSESSED.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
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