401710471-9-8-2022-17-CC-EBAY-CJ3NV3-20220908104717

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401710471
Report Date: 09/08/2022
Date Signed: 09/08/2022 10:48:43 AM

Document Has Been Signed on 09/08/2022 10:48 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:	C.L. SMITH SCHOOL		FACILITY NUMBER:	401710471
ADMINISTRATOR:	VALERIE BADA		FACILITY TYPE:	840
ADDRESS:	1375 BALBOA		TELEPHONE:	(805) 781-7447
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	65	CENSUS: 10	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Valerie Bada		TIME COMPLETED:	11:00 AM

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 9/8/22, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required inspection the abovementioned Child Care Center (CCC). LPA met with Valerie Bada, Site Supervisor of the CCC and explained the nature and purpose of the inspection. LPA, in the company of Site Supervisor, toured the interior and exterior of the CCC. The center is a School Age program which use one module classroom on the ground of C.L. Smith Elementary school. At the time of the inspection the CCC has a population of 10 children in care, along with two teacher (cleared and associated). LPA notes the Site Supervisor assist with the care and supervision of children on site. The classroom of the CCC is clean and organized. The classroom has age appropriate furnishings and play equipment available for children. The classroom has an operable carbon monoxide detectors which was tested (9:15 AM). The restrooms used by children are in safe and sanitary operating condition. One restroom is in the module classroom while two other used by children is on school grounds. Disinfectants, cleaning solutions, sharps and medication at the CCC are locked in a cabinet in the classroom. The CCC provides a mid day snacks for the children. Lunch is not served at the School Age program as the CCC is non operational during lunch hours. LPA reviewed posted menus in the classroom which outlined the future snacks to be provided. Additionally, licensing required notices are posted predominately on the classroom wall near the staff desk. LPA viewed the Sign In/Out forms for the CCC near the same location. LPA notes the forms contained the children's arrivals and exits times along with signatures of the children's authorized representatives. The CCC's outdoor playground areas, which are comprised of grass, a blacktop and a place structure area is enclosed by chain linked fencing. LPA observed age appropriate play equipment in the outdoor area. The play equipment is in suitable condition and free of sharp as well as loose or pointed objects. The play structures in the playground area have adequate cushioning materials to absorb falls. Further there is (CONT. LIC 809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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: C.L. SMITH SCHOOL	FACILITY NUMBER: 401710471
	VISIT DATE: 09/08/2022

NARRATIVE

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abundance of shade (i.e. tress and building overhangs) in the area. No bodies of water were observed on site. There is available drinking water for children both inside and outside of the classroom. The water sources are fountains attached to the buildings. Children also bring their own drinking water to the CCC. Site Supervisor was reminded to ensure the CCC's water sources are tested for lead containments. Waste receptacles with tight fitting covers are observed throughout the center.

A sampling of staff and children records are reviewed. The children’s records were complete and found to contain emergency contact information. Staff records are reviewed and contained certifications for Pediatric First Aid/CPR (EMSA approved) and Mandated Reporter, Site Supervisor noted no firearms or ammunition are stored on the premises.

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 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

Facility representative 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.

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

Exit interview conducted and report was reviewed with the Facility representative Valerie Bada.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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