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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401701939
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:24:42 PM


Document Has Been Signed on 08/01/2023 02:24 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: 49DATE:
08/01/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Doris AngelTIME COMPLETED:
01:04 PM
NARRATIVE
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On August 1st, 2023, at 10:17AM Licensing Program Analysts (LPAs) Rosie Breault and Susana Martinez conducted an announced Annual/Random inspection. LPAs met with Director Doris Angel and advised her the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. The facility operates Monday through Friday 7:30am - 5:30pm. This facility is located on the grounds of Peace Lutheran Church. At the time of the inspection there were forty-nine (49) children, and eight (8) staff present. Director also submitted a change of capacity which will be reflected in this report.

LPAs observed required licensing documents mounted on the wall at the entrance of the facility. Parents use “Playground” app for signing in and out and at the time of the inspection, roster was current. The facility is currently utilizing four (4) classrooms for care and supervision. Each of the classrooms have ample ventilation, age-appropriate toys, and furniture readily accessible for children in care. Children nap on mats and their individual bedding is stored separately. Children bring their own water bottles and facility also provides filter water for use. LPAs observed all cleaning compounds, disinfectants, sharps, combustibles, and tools to be elevated and inaccessible to children. LPAs observed the facility has a sufficient number of restrooms and sinks available for the children, which were functioning and clean at the time of the inspection. Facility provides AM and PM snack, and LPAs observed kitchen to be clean, free of rodents, and appliances in working order. Fire extinguisher was last serviced on 4/10/2023 and last emergency drill was conducted on 6/22/2023. Carbon Monoxide detectors were tested and were functioning at the time of the inspection. Per director, no firearms or ammunition are present on property.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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Document Has Been Signed on 08/01/2023 02:24 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: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on director statement the licensee did not comply with the section cited above in one cpunt which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2023
Plan of Correction
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Director to submit results of lead testing to CCLD Regional Office: 6500 Hollister Ave Suite 200 Santa Barbara CA 93117
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 5 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Director to provide proof of in person infant/ pediatric EMSA certified certificates to 6500 Hollister Ave Suite 200 Santa Barbara CA no later than 8/31/02023.
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: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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: 08/01/2023
NARRATIVE
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LPAs observed the outdoor area play area to have adequate amount of space for children to play with appropriate toys and equipment. LPAs observed ample shade, soft padding, and sandbox free of debris. No bodies of water are present.

Incidental Medical Services are currently being provided. LPAs observed two (2) children’s medications inside with unaltered labels and unexpired.

Per Health and Safety Code (HSC) 1597.16 (a) (1) a licensed day care constructed prior to January 1, 2010, shall have water tested for lead contamination no later than January 1, 2023. Director stated facility is scheduled to be tested “sometime in August.” Although facility provides filter water for children, this is a violation of HSC, and a Type B citation has been issued.

A sampling of children and staff records were reviewed. Teachers meet required qualifications. At the time of the inspection, no teacher present had current or valid Pediatric First Aid/CPR. This is a violation of Title 22 Division 12, and a Type B citation has been issued. LPAs reviewed AB 1207 Mandated Reporter Training certificates and advised to certify every two (2) years. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements.

The Department received a request to decrease capacity from ninety-two (92) children to eighty (80) children. Based on LPAs inspection, this facility meets Title 22 Division 12 for a capacity of eighty (80) children effective today 8/1/2023.

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 follow 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

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 08/01/2023
NARRATIVE
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Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

Deficiencies cited are attached on corresponding LIC809D.

Exit interview conducted, report reviewed, copy and appeal rights provided to Director.

THE NOTICE OF SITE VISIT WAS 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 OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4