401711738-9-8-2021-17-CC-EBAY-C6NVNJ-20210908163513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401711738
Report Date: 09/08/2021
Date Signed: 09/08/2021 04:37:29 PM

Document Has Been Signed on 09/08/2021 04:37 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:	BRANCH ELEMENTARY SCHOOL		FACILITY NUMBER:	401711738
ADMINISTRATOR:	ELLIOTT, KRISTIN		FACILITY TYPE:	840
ADDRESS:	970 SCHOOL ROAD		TELEPHONE:	(805) 473-5476
CITY:	ARROYO GRANDE	STATE: CA	ZIP CODE:	93420
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 0	CENSUS: 9	DATE:	09/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Carrie Van Beveren		TIME COMPLETED:	03:30 PM

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 9/8/21, at 2:00 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required inspection the abovementioned Child Care Center (CCC). LPAs met with Carrie Van Beveren, Administrator of the CCC and explained the purpose of the inspection. LPA, in the company of Administrator toured the interior and exterior of the CCC. The CCC is a School Age program which one classroom on the grounds of Branch Elementary school. The CCC operated 7:00 AM- 9:35 AM on Mondays and 7:00 AM -8-45 AM Tuesday-Friday. Likewise, the CCC operates in the afternoon from 1:30 PM- 6:00 PM Monday- Friday. At the time of the inspection the CCC has a population of 9 children in care, along with three teacher providing supervision. The classroom of the CCC is clean and organized. LPA observed LPA reviewed licensing required notices posted predominately on the walls near the classroom's entry/exit. The classroom has age appropriate furnishings and play equipment available for children in care as well as an operable carbon monoxide detector. Disinfectants, cleaning supplies, medication and sharps are secured in cabinets in the CCC's classroom. The items enclosed in the cabinet are inaccessible to children in care. The CCC provides snacks and has water available for children both inside and outside of the classroom. The Sign In/Out forms for the CCC were observed near the entry of the classroom. Waste receptacles in the interior and exterior of the CCC are observed to have tight fitting covers. The restroom used by children in care is clean and free of toxins. Children are escorted to and from the restrooms by the CCC's staff members. The CCC's outdoor playground areas are enclosed by chain linked fencing. The CCC share playgrounds with students of the elementary school, however playground use and activities are segregated from elementary school activities and play. LPAs observed age appropriate equipment in the playground areas. The equipment is in suitable condition and free of sharp as well as loose or pointed objects. The play structures in the playground areas have adequate cushioning materials to absorb falls and shade created by trees covered (CONT. 809-C)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: BRANCH ELEMENTARY SCHOOL	FACILITY NUMBER: 401711738
	VISIT DATE: 09/08/2021

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
26
27
28
29
30
31
32

areas. LPA observed no bodies of water on site

A sampling of staff and children's records were reviewed. The children’s records were complete and found to contain emergency contact information. Staff records were reviewed and found to be current CPR/First Aid certifications as well as,Mandated Reporter training cerifications. LPA no firearm or ammunition are stored on the site.

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 Family Child Care Homes Section 102417. 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

LPA discussed COVID-19 best practices and guidance with Administrator. Administrator was reminded of Administrator's responsibility to know the regulations for CCC which can be accessed on-line at www.ccld.ca.gov.

In areas evaluated, no deficiencies observed.

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

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2