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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401712170
Report Date: 09/13/2022
Date Signed: 09/13/2022 03:48:52 PM

Document Has Been Signed on 09/13/2022 03:48 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:ST. ROSE SCHOOLFACILITY NUMBER:
401712170
ADMINISTRATOR:CHAMBERLAIN, LORIFACILITY TYPE:
850
ADDRESS:820 CRESTON RD.TELEPHONE:
(805) 238-0304
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 19DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Lori ChamberlainTIME COMPLETED:
04:02 PM
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On September 13, 2022 at 2:05 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with facility Director Lori Chamberlain and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 19 children in care at the time of the inspection.

The facility is using one (1) classroom for children in care. LPA observed licensing required documents posted prominently on the wall in view. Facility has enough restrooms for children in care. LPA observed a facility snack schedule. Facility offers a morning and afternoon snack. Children bring their own lunch from home. LPA did not observe any hazards/toxins items accessible to children in care. Facility stores cleaners and disinfectants on a top shelf and up in a cabinet out of reach from children in care. The classroom has age appropriate toys, books, activities, and furniture readily accessible for children in care. The outdoor playground has an ample amount of space and shade for children to play. LPA observed the playground has age appropriate toys, activities, and structures available for children to use. They have an area with play structures, a sandbox, and tables for other activities. The facility has water available for children inside and out. Children bring their own water bottles from home. Facility staff clean and refill the water bottles when needed.

A sampling of children and staff records were reviewed. LPA observed 10 children's files to be complete and current. LPA observed staff files to be complete and current. Teachers meet the required qualifications. Staff present have a current Pediatric CPR/First-Aid and Mandated Reporter certificates. Facility is currently following Covid-19 guidelines.

No deficiencies were cited during today's inspection.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2022
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: ST. ROSE SCHOOL
FACILITY NUMBER: 401712170
VISIT DATE: 09/13/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, 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 Family Child Care Home. 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.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC809 (FAS) - (06/04)
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