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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214036
Report Date: 06/17/2021
Date Signed: 06/17/2021 03:20:37 PM

Document Has Been Signed on 06/17/2021 03:20 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:
566214036
ADMINISTRATOR:SARA J. POAGEFACILITY TYPE:
830
ADDRESS:2480C E. LAS POSAS RD.TELEPHONE:
(805) 987-2132
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 35TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Dominique Ruiz-Infant/Toddler Teacher
Michelle C. Wilcox-Director		TIME COMPLETED:
12:20 PM
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On June 17, 2021 at 10:00 AM Licensing Program Analyst (LPA) Laura Villanueva made an unannounced visit to conduct a Required-1 Year inspection. LPA toured the facility with Dominique Ruiz, Infant/Toddler Teacher. The center operates Monday through Friday from 6:30 AM to 5:30 PM. In the classroom a Teacher was caring for 2 infants on the carpet while 1 infant slept in a crib.

LPA observed the classroom to be free of hazardous items. Furniture and outside equipment for the infants was in good condition, free of sharp, loose, or pointed parts. There were enough toys and cribs for the children in care. Each infant has a written Infant/Toddler information sheet. LPA advised Center Director that an LIC 9227 Individual infant sleeping plan must be completed daily for each infant pursuant to Title 22, Section 101429(a)(2)(c). An LIC 9102 Advisory Notes - Technical Violation was issued.

The infant program is currently not providing Incidental Medical Services Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.htm

An exit interview was conducted. A copy of this report and appeal rights were discussed and left with Center Director, Michelle C. Wilcox, whose signature on this form confirm receipt of these documents.A Safe Sleep pamphlet was provided.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
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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