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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401702641
Report Date: 05/06/2022
Date Signed: 05/06/2022 12:02:54 PM


Document Has Been Signed on 05/06/2022 12:02 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:ORFALEA FAMILY & ASI CHILDREN'S CENTER RM # 133FACILITY NUMBER:
401702641
ADMINISTRATOR:ASHLEY SHOALSFACILITY TYPE:
850
ADDRESS:1 GRAND AVETELEPHONE:
(805) 756-1267
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93407
CAPACITY:96CENSUS: 84DATE:
05/06/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Ashley ShoalsTIME COMPLETED:
12:15 PM
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On 5/6/22, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management -COVID-19 inspection and met with Ashley Shoals, Director of Child Care Center (CCC) . LPA informed of the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. Director provided LPA a facility tour, inside and outside. LPA notes 84 children are in care at the time of the inspection.

This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCLD on 4/28/22. CCLD provided a Tele Rapid Assistance Support Team (RAST) inspection on 7/7/20, where LPA (Upchurch) provided COVID-19 resources, current Childcare Industry Guidance, and a COVID-19 self-assessment guide to the facility.

LPA observed facility staff wearing masks upon arrival to the facility. The CCC has COVID postings at the main entry, along with a large COVID-19 Questionnaire poster. Upon entry into the CCC, individuals wash their hands. LPA also observed hand sanitizing containers readily available.

Within each classroom, the CCC has cleaning solutions and compounds which are easily accessible to staff members yet beyond the reach of children in care. The CCC has a dedicated staff member who cleans and sanitizing items in the CCC.

LPA discussed facility’s written plan for when a staff member or child tests positive for COVID-19 and developing a written communication plan with parents/guardians to share information and guidelines in their preferred language. LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, Hand washing, Food Service and Meal Times, How to Respond to Exposures or Outbreaks, and Resilience
(CONT. 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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: ORFALEA FAMILY & ASI CHILDREN'S CENTER RM # 133
FACILITY NUMBER: 401702641
VISIT DATE: 05/06/2022
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ttps during the Pandemic.

LPA noted CCC maintains a current COVID-19 Child Care Program Self-Assessment Guide/Mitigation plan. which has been provided by the Department. LPA also provided the following resources:
- Official Public Health and Child Care Guidance for COVID-19 – Updated 1/26/2022.
- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection.

A Notice of Site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Exit interview conducted and report was reviewed with the Director Ashley Shoal
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC809 (FAS) - (06/04)
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