401712170-9-27-2019-17-CC-MKST-BGER8R-20190927124823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401712170
Report Date: 09/27/2019
Date Signed: 09/27/2019 12:48:30 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:	ST. ROSE SCHOOL		FACILITY NUMBER:	401712170
ADMINISTRATOR:	CHAMBERLAIN, LORI		FACILITY TYPE:	850
ADDRESS:	820 CRESTON RD.		TELEPHONE:	(805) 238-0304
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	25	CENSUS: 0	DATE:	09/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Lori Chamberlain		TIME COMPLETED:	12:50 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	Licensing Program Analyst (LPA), Melissa Stewart, conducted an annual random inspection and met with Director, Lori Chamberlain. The purpose of the inspection was explained. The center operates Monday - Friday 7:30am-5:30pm. There were no children present at the time of inspection as the center was closed to children for a staff development day. Director accompanied LPA on a tour of the classroom and the outdoor activity area. Director provided staff records and a random sample of children's records for LPA review. Director informed LPA that she had planned to leave for the day at 12:00 pm and requested that the St. Rose Elementary School Principal be permitted to receive and sign the Licensing Report. LPA reviewed and provided Director with a copy of “Child Care Providers Guide to Safe Sleep.” Director reported that families have been provided with the “Effects of Lead Exposure" brochure. Director prints and distributes Quarterly Updates for her staff. Director left the center at 12:10pm. All required forms, including snack menu, are posted at the main entrance of the center. The classroom is clean, organized and free of toxins. LPA observed age appropriate toys, books, games, and nap mats. Sheets for nap mats are stored separately. The cleaning products are stored inaccessible to children. The last fire/emergency disaster drill was conducted on 9/10/19 at 9:30am. There is carbon monoxide detector in the center. Director reported that there are no firearms, ammunition or bodies of water on the premises. LPA observed the medication is stored in a locked box in a cabinet which is inaccessible to children. The first aid kit was inspected and found to be complete. The restroom was observed to clean and free of toxins. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

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: ST. ROSE SCHOOL	FACILITY NUMBER: 401712170
	VISIT DATE: 09/27/2019

NARRATIVE

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The outdoor play area is completely fenced. LPA observed age appropriate toys, play structure with appropriate cushioning, shade area, grass area, play houses and sand box. There is a drinking fountain in the outdoor play area.

This facility provides Incidental Medical Services – IMS. LPA reviewed current IMS Plan of Operation. 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: www.ada.gov/childqanda.htm

A sample of staff files were reviewed and found to be complete. Director's CPR and First aid expires 8/14/21. Staff completed the Mandated Reporter Training per AB 1207 and have met immunization requirements per SB 792. Children's roster was reviewed. Sampling of children's records reviewed and found complete.

In areas evaluated, no deficiencies cited.

LPA observed the Notice of Site visit posted.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

LIC809 (FAS) - (06/04)

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