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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406205649
Report Date: 05/25/2023
Date Signed: 05/25/2023 02:14:23 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/25/2023 02:14 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CHILDREN'S GARDEN, THEFACILITY NUMBER:
406205649
ADMINISTRATOR:MERCEDES PETWAYFACILITY TYPE:
840
ADDRESS:701 CROCKER ST.TELEPHONE:
(805) 434-1188
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY:30CENSUS: 17DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Mercedes PetwayTIME COMPLETED:
02:15 PM
NARRATIVE
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On May 25th, 2023 at 8:30 AM, Licensing Program Analyst (LPA) Dixie Wright and Licensing Program Manager (LPM) Maria Mueller conducted an Annual/Required inspection. LPA met with Director Mercedes Petway and advised her of the purpose of the inspection. Director provided a facility tour, both inside and outside. Licensee Jeanne Hunt arrived at approximately 11:20 AM during the inspection.

The program currently has 67 school age children enrolled, all attending at different blocks of time. There were 11 school age children at the time of the inspection. There were three teachers present, not including the Director. Staff to child ratio was within guidelines. The facility operates Mon-Fri 7:00 AM to 5:30 PM.

The facility has a primary main room and outdoor play area. LPA observed required postings on the wall of the main room, prominently in view. Facility has enough restrooms for children in care. Children bring their own lunch, the facility provides three snacks a day, and provides breakfast. Breakfast today was muffins, milk, oatmeal, cold cereal and strawberries. There was a menu observed for the snacks. There are hooks at the entrance for children's belongings. Children bring their own water cups and the facility provides filtered water, which was observed in the kitchen. Age appropriate toys, books, supplies for activities, furniture and playground equipment were observed. There is ample shade and space for the children. Smoke alarm/Carbon monoxide detector was tested and functioning at 11:20AM. Last disaster drill was done on 04/28/2023. The facility was tested for lead on 12/16/2022 by a certified Lead Inspector, and report dated 12/24/2022 shows the facility water is well below the action level of lead and water can be continued to be used.

There is a shed in the playground area that did not have a lock and was accessible to children. In the shed, LPA observed Gardening Tools, Weed B Gon, Pure Bright germicidal bleach, and oxy deep cleaner. There was a plastic storage with drawers, in the drawers a hammer, screwdrivers, wrench, hooks etc. were observed. There were three trash cans observed with lids, but the lids had a hole on them.

Continued on 809-C...

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649
VISIT DATE: 05/25/2023
NARRATIVE
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LPA and LPM toured the back storage room area where the refrigerator is. There are lockers for the staff that did not have locks. In two of the lockers, prescription medication, over the counter TUMS and prenatal vitamins were observed. Staff purses and handbags were hanging in the room, in one of the bags was a prescription medication. All were found to be potentially accessible to children. There were three pairs of adult, sharp scissors also observed accessible to children. There was three sharp knives in a drawer in the middle kitchen. In the refrigerator was a bowl of cheese, uncovered. Director removed the bowl of cheese in LPA's presence. In the middle kitchen, the locked medicine cabinet had the key stored next to it. In the medicine cabinet, there was children's ibuprofen and two inhalers observed with no labels.

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 facility will submit an IMS plan for the inhaler found in the medicine cabinet. 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

Director 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.

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.

Upon receipt, provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. (LIC 9224 was provided to the Center.) Appeal Rights were provided to Licensee and Director.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Mercedes Petway.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 05/25/2023 02:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
CCR
101239(f)(1)

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Buildings and Grounds- Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins,
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Per Director, they will replace the lids with holes with garbage lids that are enclosed. Proof of Correction will be sent to CCLD by 06/02/2023
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shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. This requirement is not met as evidenced by: Based on observation, three garbages observed with lids with holes in the top.
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Type B
06/02/2023
Section Cited
CCR101226(e)(B)(3)

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Health Related Services- Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the
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Per Director, they will not dispense medications until there is a written Incidental Medical Services plan in place, and written authorization in place. Proof of Correction will be sent to CCLD by 06/02/2023.
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child. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Children's ibuprofen and inhaler did not have IMS plan or written authorization.
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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: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 05/25/2023 02:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/02/2023
Section Cited
CCR
101238(g)(1)

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Buildings and Grounds- Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.(1) Storage areas for poisons shall be locked. This requirement was not met as evidenced by: There were unlocked
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Per Director, they will make sure the back shed is locked, all the staff lockers have locks, and all sharps such as scissors and knives, will be kept were inaccessible to children. Proof of Correction will be sent to CCLD by 06/02/2023
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gardening tools hammers, screwdrivers, and cleaning supplies observed unlocked in outside shed. There were unlocked prescription medications and three pairs of sharp scissors observed in the supply room area and three sharp knives observed in a drawer unlocked in middle kitchen area.
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Type A
06/02/2023
Section Cited
CCR101226(e)(3)(B)

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Health Related Services- In centers where the licensee chooses to handle medications:(1)All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below:(B)Each container shall have
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Per Director, they will make sure any medications stored on the premises to dispense to children will have a label. Proof of Correction will be sent to CCLD by 06/02/2023.
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an unaltered label. This requirement was not met as evidenced by: Medication cabinet
had Children's Ibuprofen and Inhaler with no labels.
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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: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 05/25/2023 02:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: CHILDREN'S GARDEN, THE
FACILITY NUMBER: 406205649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
CCR
101229.1(1)(b)

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Sign In and Sign Out-(1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by: Sign in sheet was missing
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Per Director, they will ensure all parents/legal guardians sign in and sign out the children, with full signatures. Proof of Correction will be sent to CCLD by 06/02/2023
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one sign in signatures out of 32 children.
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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: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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