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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213440
Report Date: 05/26/2022
Date Signed: 05/26/2022 04:26:38 PM

Document Has Been Signed on 05/26/2022 04:26 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:GOOD SHEPHERD LUTHERAN EARLY CHILDHOOD CENTERFACILITY NUMBER:
566213440
ADMINISTRATOR:VERONICA MARINFACILITY TYPE:
850
ADDRESS:380 ARNEILL ROADTELEPHONE:
(805) 482-3411
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 37DATE:
05/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jasmin MunguiaTIME COMPLETED:
01:35 PM
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On 5/262022 at 10:00 AM, Licensing Program Analysts (LPA) MIchael Mathew conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with interim director Jasmine Munguia and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 37 children in care and 8 staff at the time of the inspection.

On 3/24/2022 at 5:00 PM C1 was playing with a belly board in the front playground which has a very small ramp that C1 was rolling down and cut this pinky, S1 immediately went to assist C1 and was cleaning the wound. S2 was with other children assisting them in the bathroom. When S2 came back, S1 and S2 where seeing how bad the finger was,At 5:10 after the incident has happened S2 reported the incident to Procare, an app that the facility uses to communicate to parents, facility did not call parents since parents were on the way. At 5:23 C1s mom came and picked up child.

On 3/25/2022 During play time S3 notice that C1 was not using his fingers and noticed that it was bruised, S3 messaged mom on app and C1 was picked up at the end of the day.

Based on the information obtained from the Director as well as the LPA's observations, LPA determined there were no deficiencies and that Director and CCC functioned in accordance with Title 22 regulations. No deficiencies were cited during today's visit.

Exit interview conducted with interim DirectorJasmine Munguia, . A copy of this report was reviewed and provided to the Director
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2022
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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