401701939-3-24-2022-17-CC-FPEA-CCTUDJ-20220324152936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401701939
Report Date: 03/24/2022
Date Signed: 03/24/2022 03:29:45 PM

Document Has Been Signed on 03/24/2022 03:29 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:	PEACE CHRISTIAN PRESCHOOL		FACILITY NUMBER:	401701939
ADMINISTRATOR:	DORIS ANGEL		FACILITY TYPE:	850
ADDRESS:	244 OAK PARK BLVD		TELEPHONE:	(805) 489-9644
CITY:	ARROYO GRANDE	STATE: CA	ZIP CODE:	93420
CAPACITY:	92	CENSUS: 50	DATE:	03/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:46 AM
MET WITH:	Doris		TIME COMPLETED:	03:44 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On March 24, 2022 at 11:46 AM, Licensing Program Analysts (LPAs) Frank Pedroza and Rosie Breault conducted an unannounced Annual/Random inspection. LPAs met with facility Director Doris Angel and advised her the purpose of the inspection. Director Provided LPAs a tour of the facility inside and out. There were 50 children in care at the time of the inspection. LPAs observed required licensing documents mounted on the wall at the entrance of each classroom and Director's office. The center has five (5) classrooms available for use. LPAs observed a posted snack menu. Currently the center provides a morning and afternoon snack for children in care. Children bring their own lunch from home. LPAs observed the facility has enough restrooms available for the children. LPAs did not observe any hazards/toxins items accessible to children in care. Each of the classrooms have age appropriate toys and furniture readily accessible for children in care. Facility provides children that are staying full day a sleeping cot during quiet time if they choose to sleep. The outdoor playground has an ample amount of space for children to play. LPAs observed the playground has age appropriate toys and structures available for children to use. LPAs observed an ample amount of shade available outside. The facility has water available for children inside and out. Children use their own water bottles if they have them labeled with their name. A sampling of children and staff records were reviewed. Currently the facility does not have children that require Incident Medical services (IMS). LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Teachers meet the required qualifications. There was a teacher present with a current Pediatric CPR/First-Aid certificate that is valid until 08/10/2023. LPAs reviewed six (6) staff files with expired or no Mandated Reporter certificates available. Staff are required to take Mandated Reporter training every two (2) years. LPAs reviewed three (3) children files with no signed LIC 9224 Acknowledgement of Receipt of Licensing Reports forms available. Facility is required to have a signed LIC 9224 form present in every child's file for one (1) from the date of the citation. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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: PEACE CHRISTIAN PRESCHOOL	FACILITY NUMBER: 401701939
	VISIT DATE: 03/24/2022

NARRATIVE

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Pursuant to Title 22 of the California Code of Regulations, the following Type B deficiencies are cited (refer to LIC 809-D).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home Section 102417. When any IMS is provided, a plan for providing 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director. Director provided appeal rights.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/24/2022 03:29 PM - It Cannot Be Edited

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: PEACE CHRISTIAN PRESCHOOL	FACILITY NUMBER: 401701939
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation and record review, the licensee did not comply with the section cited above in 6 out of 9 staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2022
	Plan of Correction
1 2 3 4	Facility director will submit a written plan of correction (POC) documenting when staff have completed the Mandated Reporter training. Directors POC will be due on 04/04/2022.

Type B

Section Cited

HSC

1596.8595(c)(1)

(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation and record review, the licensee did not comply with the section cited above in 3 out of 10 children files did not have a signed LIC 9224-Acknowledgement of Receipt of Licensing Reports which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2022
	Plan of Correction
1 2 3 4	Facility director will submit a written plan of correction (POC) documenting when the children's files have been updated with the completed LIC 9224 forms in their files. Directors POC will be due on 04/04/2022.

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: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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