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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406205649
Report Date: 11/03/2021
Date Signed: 11/03/2021 06:06:39 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:CHILDREN'S GARDEN, THEFACILITY NUMBER:
406205649
ADMINISTRATOR:GINA GOETSCHFACILITY TYPE:
840
ADDRESS:701 CROCKER ST.TELEPHONE:
(805) 434-1188
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY:30CENSUS: 31DATE:
11/03/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Mercedes PetwayTIME COMPLETED:
04:00 PM
NARRATIVE
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On 11/3/2021, at 2:35 PM, Licensing Program Analyst Gigi Reyes conducted an unannounced Case Management Inspection. Prior to inspection, LPA asked pre screening questions related to COVID 19. Director's responses indicate there are no COVID 19 exposure on site. LPA Reyes met with Mercedes Petway, designated Director and discussed the purpose of the inspection.

Upon arrival, LPA Reyes observed and counted that there were 31 children present supervised by Director and one Staff. Center is licensed for a capacity of 30 School Age Children. LPA also observed that Center is out of ratio at the time of the inspection, 2 Staff supervising 31 School Age Children.

Director Mercedes Petway stated that 2 families with 4 school age children were not picked up as scheduled.

On 10/12/2021, LPA Reyes interviewed the then Director Gina Goetsch if there was any Positive Case of COVID 19 among individuals that attend/go to School Age Program, Director stated there was none. Director believed that it was an exposure from a family member.

On 10/13/2021, it was cross reported to CCLD that an individual at the Center contracted COVID on or about 8/28/2021. The said positive case was not reported to the Department as required by regulation 101212(d)(E) Reporting Requirements

Continued on LIC 809
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649
VISIT DATE: 11/03/2021
NARRATIVE
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The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited:

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Director Mercedes Petway
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2021
Section Cited

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101161 Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement is not met as evidenced by :
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Upon arrival, LPA counted and observed that thre were 31 children present as opposed to capacity limit of 30. This poses an immediate risk to health and safety of children in care.
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Type A
11/04/2021
Section Cited

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101516.5 Teacher-Child Ratio
b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.
(1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement is not met as evidenced by:
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LPA observed 31 school age childre were supervised by one staff and a Director. This poses an immediate risk to health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2021
Section Cited

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101212(d)(E) Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events... Department's next working day and during its normal business hours. (1) Events reported shall include the following
(E) Epidemic outbreaks. This requirement is not met as evidenced by:
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Based on LPA interview and information received by CCLD, Center failed to report a positive case of COVID 19 of an individual which occurred on or about 8/28/2021. This poses a potential risk to health and safety of chidlren in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4