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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214034
Report Date: 03/10/2022
Date Signed: 03/10/2022 08:01:01 AM

Document Has Been Signed on 03/10/2022 08:01 AM - 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:SHINING STARS PRESCHOOL & INFANT CENTERFACILITY NUMBER:
566214034
ADMINISTRATOR:MICHELLE C. WILCOXFACILITY TYPE:
850
ADDRESS:2480C E. LAS POSAS RD.TELEPHONE:
(805) 987-2132
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: DATE:
03/10/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Dominique RuizTIME COMPLETED:
08:20 AM
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On March 10, 2022 at 7:30 AM, Licensing Program Analysts (LPA) Dean Thompson conducted an unannounced Case Management – COVID-19 inspection and met with teacher Dominique Ruiz. LPA informed the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. LPA a toured of the facility, inside and outside.

This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCL between January 19, 2022 - March 9, 2022. There has not been any other positive cases reported since the last outbreak reported on March 9, 2022. A Rapid Assistance Support (RAST) call was between July/August, 2020.

LPA provided facility with a Covid 19 Child Care Program Self-Assessment Guide form which needs to be complete and submitted by March 24, 2022 to LPA via email. LPA observed staff wearing masks upon arrival to the facility. Before entering the facility covid pre-screening questionnaire were given, sanitizer is available throughout the facility, and safety posters were posted.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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: SHINING STARS PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 566214034
VISIT DATE: 03/10/2022
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LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, Hand washing, Food Service and Mealtimes, How to Respond to Exposures or Outbreaks, and Resilience Tips during the Pandemic.

LPA 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 Dominique Ruiz
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
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