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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401701939
Report Date: 11/01/2022
Date Signed: 11/01/2022 03:11:27 PM


Document Has Been Signed on 11/01/2022 03:11 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 PRESCHOOLFACILITY NUMBER:
401701939
ADMINISTRATOR:DORIS ANGELFACILITY TYPE:
850
ADDRESS:244 OAK PARK BLVDTELEPHONE:
(805) 489-9644
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:92CENSUS: 41DATE:
11/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Doris AngelTIME COMPLETED:
03:30 PM
NARRATIVE
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On 11/1/22, at 1:50 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management Inspection of the abovementioned Child Care Center (CCC) as a follow up to a self reported Unusual Incident Report (UIR) received by the Department on 10/26/22. Circumstances of the UIR involved a child, herein C1, being left unattended in the classroom.

The LPA met with Doris Angel, Director of the CCC and explained the purpose of the inspection. LPA notes 41 children are on site during the inspection along with 9 teachers.

LPA discussed the incident with the Director. Director confirmed C1 was left in the classroom (#4) after children and staff exited the classroom to receive brief instructions on the operation of new playground equipment. CCC staff conducted a count of children prior to exiting the classroom. C1 was reportedly left unattended for five minutes prior to being discovered in the classroom by CCC staff. LPA notes C1 was not injured or harmed during the course of the incident and the door to the classroom where C1 remained was left open.

A type A deficiency is being cited in accordance to Title 22 of the California Code of Regulations. Please refer to LIC 809 D for documentation of deficiency cited:

LPA forwarded a Notice of Site Visit which is to be posted as required by H&S Code Sec.1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty $100.00 may apply.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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 11/01/2022 03:11 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: 11/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/02/2022
Section Cited

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Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision ...to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher ... visual observation.
This requirement is not met as evidenced by:
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Based on LPA's observations, interview, record review, C1 was left unattended in the CCC classroom (#4). This is an immediate risk to the health and safety of the children in the facility.
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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