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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214036
Report Date: 02/10/2023
Date Signed: 02/10/2023 05:09:50 PM

Document Has Been Signed on 02/10/2023 05:09 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:ARMIDA LUEVANOFACILITY TYPE:
830
ADDRESS:2480C E. LAS POSAS RD.TELEPHONE:
(805) 987-2132
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 10DATE:
02/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Armida LuevanoTIME COMPLETED:
05:30 PM
NARRATIVE
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On February 10, 2023 at 2:30 PM Licensing Program Analyst (LPA) Laura Villanueva conducted an unannounced visit to conduct a Case Management-Deficiencies inspection. LPA met with director, Armida Luevano and explained the purpose for the inspection. Prior to entering the facility, LPA asked pre-screening questions related to COVID-19. Responses suggest no COVID exposure on site. LPA conducted a tour of the facility inside and outside with director.

During a complaint investigation, it was found that an infant was sleeping swaddled in a baby seat. Staff stated that the parent requested the child be swaddled and provided the cover. A picture of the child was received with the complaint. The child had a severe red rash on his face. LPA provided director the safe sleep regulations.A type A deficiency was issued in section 102425 Infant Safe Sleep (f) An infant shall not be swaddled while in care. Please refer to LIC809D for documentation of deficiencies cited.

LPA observed the infant classroom to have 2 saucer chairs present. Staff informed LPA that they were donated by a parent. LPA provided director with a flyer on prohibited items in child cares. A Type B deficiency was issued under section 101439(c) Infant Care Center Fixtures, Furniture, Equipment and Supplies A "baby walker" means any article described in paragraph (4) of subdivision (a) of Section 1500.86 of Part 1500 of Title 16 of the Code of Federal Regulations. A Type B deficiency was given under section 101439(c) Infant Care Center Fixtures, Furniture, Equipment and Supplies. was cited in section 1596 being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety. Please refer to LIC809D for documentation of deficiencies cited.


Continued on LIC809C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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: 566214036
VISIT DATE: 02/10/2023
NARRATIVE
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After child file review, LPA observed the file to be incomplete. Child was enrolled without all required documentation completed. The forms that were missing are: LIC700 Child Identification form and LIC702 Child Preadmission Heath History. A type B was issued for section Child's Records 101221(a) A separate, complete and current record for each child is maintained in the child care center. Please refer to LIC809D for documentation of deficiencies cited.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensingCopies of this report must be posted for 30 days in a visible location for the authorized representatives of children. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Director, Armida Luevano. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Director’s signature on this form acknowledges receipt of these rights.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/10/2023 05:09 PM - It Cannot Be Edited


Created By: Laura Villanueva On 02/09/2023 at 04:55 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: 566214036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2023
Section Cited
HSC
102425(f)

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Infant Safe Sleep-102425 (f) An infant shall not be swaddled while in care.

This requirement was not met as evidenced by:
A picture submitted in complaint showing an infant swaddled in an infant seat.
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LPA advised director that an infant shall not be swaddled at any time. LPA gave a copy of infant safe sleep regulations to director.

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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: 02/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/08/2023 02:32 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/07/2023 07:37 PM


Created By: Laura Villanueva On 02/09/2023 at 04:55 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SHINING STARS PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 566214036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
Section Cited
HSC
101439(c)

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101439(c) Infant Care Center Fixtures, Furniture, Equipment and Supplies- (c) A "baby walker" means any article described in paragraph (4) of subdivision (a) of Section 1500.86 of Part 1500 of Title 16 of the Code of Federal Regulations.
This requirement is not met as evidenced by:
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LPA advised director that type of infant equipment is not permitted at the child care center. Director took the devices out of the room and threw them in the trash while LPA was present.
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LPA observed and took pictures of 2 infant saucer chairs in the infant classroom.
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Type B
02/10/2023
Section Cited
CCR101212(d)(1)(B)

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101212(d)(1)((B) Any injury to any child that requires medical treatment.))-Reporting Requirements -Upon the occurrence, during the operation of the child care center...within seven days following the occurrence of such event.(1) Events reported shall include the following: (B)Any injury to any child that requires medical treatment.
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Staff shall inform families of cleaning agents used around the children in care. Staff shall document parents received information in child's file. To be completed by 3/20/23.
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C1 was not provided a safe and healthful environment. C1 developed a rash on his face, and the staff failed to investigate the cause of the rash. There was no evidence of any follow-up from staff as to the cause of the rash.
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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: 02/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023


LIC809 (FAS) - (06/04)
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