401711738-5-12-2022-17-CC-EBAY-CECNNG-20220512103645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401711738
Report Date: 05/12/2022
Date Signed: 05/12/2022 04:18:04 PM

Document Has Been Signed on 05/12/2022 04:18 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: 42	CENSUS:	DATE:	05/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Carrie Van Beveren		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 5/12/22, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required Inspection of the abovementioned Child Care Center (CCC). LPA met with Carrie Van Beveren, Administrator of the CCC and explained 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 with two classroom on the grounds of Branch Elementary school. The CCC operated from 7:00 AM- 9:35 AM on Mondays from 7:00 AM -8:40 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 no children in care, as children transition to the elementary school before LPA's arrival. The classrooms of the CCC are clean and organized. LPA observed 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 detectors, one of which was tested at 9:15 AM. 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 water is available for children both inside and outside of the classrooms. 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 (foot press lids) . The restrooms used by children in care, four in total, are clean and free of toxins. Children are escorted to and from the restrooms by the CCC's staff members during the day. 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. LPA observed age appropriate equipment in the playground areas. The (CONT. 809-C)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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: BRANCH ELEMENTARY SCHOOL	FACILITY NUMBER: 401711738
	VISIT DATE: 05/12/2022

NARRATIVE

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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 (i.e. sand and foam base) and shade created by trees and building overhangs. 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 certifications. LPA notes no firearm or ammunition are stored on the site.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

Administrator was reminded that all adults 18 and over working in the CCC, 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 licensed 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 Administrator Carrie Van Beveren.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

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