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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214034
Report Date: 06/30/2022
Date Signed: 07/01/2022 01:24:38 PM

Document Has Been Signed on 07/01/2022 01:24 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: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: 29DATE:
06/30/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Armida LuevanoTIME COMPLETED:
03:00 PM
NARRATIVE
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On June 30, 2022 at 1:45PM, Licensing Program Analyst (LPA) Laura Villanueva conducted a Case Management-Annual Continuation report to document deficiencies on Annual Required report. LPA experienced technical difficulties during inspection. LPA reviewed report with Director, Amida Luevano.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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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Document Has Been Signed on 07/01/2022 01:24 PM - It Cannot Be Edited


Created By: Laura Villanueva On 06/30/2022 at 05:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SHINING STARS PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 566214034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

The music outdoor structure has sharp wires exposed accessible to the children. An office meeting will be scheduled.
POC Due Date: 07/01/2022
Plan of Correction
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The Director placed masking tape on the wire to temporary keep it off linits to the children. An office meeting will be scheduled.
Type A
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

The concrete path for the children to ride tricycles is lifted by tree roots causing a tripping hazard.
POC Due Date: 08/05/2022
Plan of Correction
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The concrete path shall be patched or evened out to make it a smooth surface for children to get through safely.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022


LIC809 (FAS) - (06/04)
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