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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401711738
Report Date: 09/28/2021
Date Signed: 09/28/2021 09:48:40 AM

Document Has Been Signed on 09/28/2021 09:48 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:BRANCH ELEMENTARY SCHOOLFACILITY NUMBER:
401711738
ADMINISTRATOR:ELLIOTT, KRISTINFACILITY TYPE:
840
ADDRESS:970 SCHOOL ROADTELEPHONE:
(805) 473-5476
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY: 42TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carrie Van Beveren, TIME COMPLETED:
10:15 AM
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On 9/28/21, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management Inspection of the abovementioned Child Care Center (CCC) at the request of the Licensee. Specifically, Carrie Van Beveren, Administrator of the CCC, requested an inspection of a classroom as a supplemental child care space. The classroom like the CCC is on the grounds of Branch Elementary school.

LPA met with the 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 operates 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 LPA observed no children in care.

On 9/24/21, the Administrator, via email, contacted the Department and requested the use of an on site classroom for child care which had not been previously been approved/licensed. Administrator also noted the classroom would afford for additional space in order for the CCC to function in accordance to COVID guidance/best practices. The classroom allows the CCC to maximize cleaning standards while adhering to social distance guidelines.

LPA inspected Room 5 also referred to as the Mathematic Laboratory, and found the room to be free of hazards. The room is in good order with ample ventilation. The room also contained two entry/exit doors as well as an operable carbon a monoxide detector (tested 9:15 AM) and a fire sprinkler system. LPA observed age appropriate furnishing in the classroom. The room has space to accommodate children in care.

Effective 9/28/21, Branch Elementary school's Room 5 is appropriate for use as a supplemental space for child care services for the CCC. LPA notes no deficiencies cited at this time. LPA provided a Notice of Site visit

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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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