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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216153
Report Date: 08/18/2021
Date Signed: 08/18/2021 11:28:14 AM

Document Has Been Signed on 08/18/2021 11:28 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:LARRIVEE FCC AKA SUNNYSIDE ADVENTURES PRESCHOOLFACILITY NUMBER:
566216153
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/18/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Kimberly LarriveeTIME COMPLETED:
11:37 AM
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On August 18, 2021, at 8:58 AM Licensing Program Analyst (LPA) Austin Rios conducted an announced visit for the purpose of completing a pre-licensing inspection. LPA met with Applicant Kimberly Larrivee and explained the nature and the purpose of the inspection. Applicant provided LPA a tour of the home inside and out. The home is a 5 bedroom, 3 bath single story residence. Applicant will be using the living room, dining room, kitchen, one bathroom, one bedroom, and back yard for the day-care. All four other bedrooms are off limits and LPA observed a gate in the hallway preventing children from having access. The garage and other two bathrooms will be off limits and are made inaccessible to children in care.

LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher purchased in August 2021 was observed in the bedroom closet. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed the home has a functioning smoke and carbon monoxide detectors. In the living room, LPA observed a fireplace with a glass screen in the front preventing children from having access. There were age appropriate toys and day-care equipment in the home. LPA observed the home to be clean and orderly. Applicant stated they do not have firearms and ammunition in the home. Applicant has a hot tub with a cover over it and is secured down with tight locks on each side. Detergents and cleaning compounds are stored out of reach of children. The bathroom to be used for children in care was observed to be clean and sanitary. The back yard has age appropriate toys, day-care equipment, and a fence. LPA observed sufficient amount of shade for children to have access to.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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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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: LARRIVEE FCC AKA SUNNYSIDE ADVENTURES PRESCHOOL
FACILITY NUMBER: 566216153
VISIT DATE: 08/18/2021
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Preventative Health & Safety and Nutrition Training completed on 6/2/2021. Applicant First Aid/CPR certificate is valid until 6/2023. Applicant AB 1207 Mandated Reporter Training Certificate expires 12/28/2021. Currently the applicant does not have liability insurance and will be looking into getting some. LPA informed applicant that she will need parents to sign a waiver for the liability insurance should she not have the liability insurance. Applicant provided lease agreement to verify control of property. LPA discussed and verified SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers, and any similar object that restricts children's movement is prohibited from licensed facilities.

LPA reviewed, discussed and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted, and forms that needs to be maintained at the Family Child Care Home (FCCH). LPA discussed information about Sudden Infant Death Syndrome, Never Shake a Baby, and Capacity requirements. LPA discussed Safe Sleep regulations with applicant. Applicant was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov.

Applicant advised to monitor the CCLD website for COVID- 19 updates and guidance.
LPA reviewed Covid-19 resources with applicant (RAST Technical Assistance Visit completed).

LPA advised applicant to contact Child development Resources at (805) 485 7878

License to operate a Family Child Care facility is effective today 8/18/2021.

A copy of this report was reviewed and provided to the applicant. Notice of Site visit posted (LIC9213).

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC809 (FAS) - (06/04)
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