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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401711736
Report Date: 06/07/2019
Date Signed: 06/09/2019 09:20:38 PM

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:OCEANVIEW ELEMENTARY SCHOOLFACILITY NUMBER:
401711736
ADMINISTRATOR:CARRIE VAN BEVERENFACILITY TYPE:
840
ADDRESS:1208 LINDA DRIVETELEPHONE:
(805) 473-5476
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:84CENSUS: 18DATE:
06/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Coni Baird, Site SupervisorTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual/random inspection and met with Site Supervisor, Ms. Connie Baird. The school is located in the Oceanview Elementary School, utilizing the school cafeteria. They follow the school district schedule; last day of school is today, 6/17/2019 and will resume on 8/15/2019. There were 18 school age children and 5 staff present. Site Supervisor stated there are no guns nor ammunition in the center. There are no bodies of water observed. The center was observed to be clean and in order.
A review of staff records and children's records were conducted as part of this evaluation.
CPR and First Aid expires in 3/20/2021. Staff have taken AB 1207 Mandated Reporter Training. Center conducts and documents fire and disaster drill, the last drill was conducted on 4/4/2019. Four (4) Staff do not have the complete record of immunization. Children's files were randomly reviewed. LPA discussed the "Effects of Lead Exposure" and provide fliers for distribution to parents.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 IMS Plan of Operation

In the areas evaluated, deficiency was cited. Appeal Rights Given. LPA observed director posted the Notice of Site Visit. on file.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019
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: OCEANVIEW ELEMENTARY SCHOOL
FACILITY NUMBER: 401711736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2019
Section Cited
HSC
1596.7995(a)(1)
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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
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Site Supervisor agreed to submit the proof of immunization to CCLD no later than 6/17/2019.
gigi.reyes@dss.ca.gov
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Based on LPA's review of sfaff record, Staff 1, Staff 2, Staff 3 and Staff 4 do not have proof of immunization. This poses a potential risk to health and safety of children in care.
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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: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019
LIC809 (FAS) - (06/04)
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