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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401712125
Report Date: 09/09/2022
Date Signed: 09/09/2022 10:31:08 AM


Document Has Been Signed on 09/09/2022 10:31 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:SINSHEIMER SUN ' N FUN PROGRAMFACILITY NUMBER:
401712125
ADMINISTRATOR:MICHELLE ROLLEFACILITY TYPE:
840
ADDRESS:2755 AUGUSTA ST.TELEPHONE:
(805) 781-7447
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:66CENSUS: 23DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Elizabeth AtwoodTIME COMPLETED:
10:30 AM
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On 9/9/22, at 8:31 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required Annual inspection of the abovementioned Child Care Center (CCC). LPA met with Elizabeth Atwood, Site Supervisor of the CCC and explained the purpose of the inspection. LPA, in the company of the Site Supervisor, toured the interior and exterior of the CCC. The CCC is located in a classroom on the grounds Sinsheimer Elementary School. The CCC operates from 7:00 AM to 6:00 PM, Monday thru Friday. The CCC has an AM program on site from 7:00 AM to 8:15 AM and a PM program on site from 2:40 PM -to 6:00 PM. LPA observed 23 children in care during the inspection along with two teacher (cleared and associated) providing care and supervision. LPA notes Site Supervisor assist with the care and supervision of children on site.

The CCC classroom has age appropriate equipment and furnishings available to children in care. LPA observed a carbon monoxide detector in the CCC which was tested at 8:45 AM and found to be operable. The bathrooms used by the children (inside the classroom and on the grounds of the elementary school) are in safe and sanitary operating condition. LPA observed an operable refrigerator in the classroom room which contains food for the children. The CCC provides a mid day snacks for the children and LPA observed a CCC menu posted. Children have available drinking water inside of the CCC and out. The water source comes from building fountains. Site Supervisor is reminded to ensure the CCC's water sources are tested for lead containments. Disinfectants, cleaning solutions, medications and sharps are locked in elevated cabinets in the classroom which is beyond the reach of children in care and secured.

LPA reviewed the CCC's Sign In/Out forms for children and notes the forms contain the children's arrival and exit times as well as the signature of the children's authorized representatives. LPA observed required licensing notices and documents posted on the wall near the rear entry/exit door of the CCC.

The CCC's outdoor playground area is enclosed by combination chain linked and wrought iron fencing. The
(CONT. 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022
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: SINSHEIMER SUN ' N FUN PROGRAM
FACILITY NUMBER: 401712125
VISIT DATE: 09/09/2022
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fence’s entry/exit gates are secured. The footing in the area is varied. LPA observed age appropriate play equipment in the play areas. The play equipment are free of sharp, loose or pointed objects. The play structures in the playground area have adequate cushioning materials to absorb falls. No bodies of water are observed on site. LPA notes the outdoor play area is shared with two of the Elementary school's kindergarten classrooms. Site Supervisor informed LPA the CCC's children play in the play area at times different (staggered) than the elementary school students.

A sampling of staff and children's records are reviewed. The children’s records are complete and found to contain emergency contact information and admission agreements. Staff records are reviewed and contained documentation to support their educational training and experience. LPA also observed current pediatric CPR/ First Aid (EMSA approved) certifications along with Mandated Reporter training certifications. Site Supervisor noted no firearm or ammunition is stored on site.

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 Elizabeth Atwood.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
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