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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207652
Report Date: 12/15/2022
Date Signed: 12/15/2022 03:28:47 PM

Document Has Been Signed on 12/15/2022 03:28 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:GREAT PACIFIC CHILD DEVELOPMENT CENTERFACILITY NUMBER:
566207652
ADMINISTRATOR:JESSICA DERBYFACILITY TYPE:
840
ADDRESS:259 W.SANTA CLARA ST. 260&280TELEPHONE:
(805) 507-8335
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 3DATE:
12/15/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jessica DerbyTIME COMPLETED:
03:45 PM
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On 12/15/2022 at 2:45 PM, Licensing Program Analyst Austin Rios conducted an unannounced Case Management – COVID-19 inspection and met with, Director Jessica Derby. LPA informed the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. Director gave LPA a tour of the facility, inside and outside.

This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCL between 12/2/2022 to 12/7/2022. CCL provided a Tele - Rapid Assistance Support Team inspection where LPA provided COVID-19 resources, current Childcare Industry Guidance, and a COVID-19 self-assessment guide to the facility.

LPA observed facility staff have mask readily available upon arrival to the facility. Children in care also had masks available. Facility does daily screening of questions to be asked upon arrival. Facility staff is cleaning during work hours and cleaning crew comes in as well after hours to clean.

LPA discussed with director their written plan for when a staff member or child tests positive for COVID-19 and director showed LPA online communication plan with parents/guardians for when someone test positive.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
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)
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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: GREAT PACIFIC CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 566207652
VISIT DATE: 12/15/2022
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LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Ventilation, Isolation for Illness, Cleaning and Disinfection, Handwashing, Food Service and Meal Times, How to Respond to Exposures or Outbreaks, and Resilience Tips during the Pandemic.

LPA reviewed that facility maintains a current Covid-19 Child Care Program Self-Assessment Guide/Mitigation plan. LPA also provided the following resources:
- Official Public Health and Child Care Guidance for COVID-19 – Updated 1/26/2022.
- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection.

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

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

Exit interview conducted and report was reviewed with the director Jessica Derby.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
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
LIC809 (FAS) - (06/04)
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