406208150-11-13-2019-17-CC-GRES-BHW87J-20191113211558

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406208150
Report Date: 11/13/2019
Date Signed: 11/13/2019 09:16:09 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 CLUBHOUSE, THE		FACILITY NUMBER:	406208150
ADMINISTRATOR:	JEANNE HUNT		FACILITY TYPE:	840
ADDRESS:	714 CROCKER ST.		TELEPHONE:	(805) 434-1188
CITY:	TEMPLETON	STATE: CA	ZIP CODE:	93465
CAPACITY:	15	CENSUS: 15	DATE:	11/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jeanne Hunt		TIME COMPLETED:	03:10 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) Gigi Reyes conducted an unannounced Annual//Random and met with Licensee/Owner, Ms. Jeanne Hunt and Director, Ms. Gina Goetsch. There were 15 school age children and 3 staff present. Physical plant tour was conducted. Classroom is equipped with age and size appropriate furniture and equipment. The backyard is appropriately fenced. Director stated there are no guns nor ammunition in the Center. LPA did not observe any bodies of water. Disinfectants, cleaning solutions are inaccessible to children in care. CPR and First Aid expires on 6/7/2021. Carbon monoxide was tested and found functional. Required Licensing Forms are posted in the prominent area. Sign in /Sign out record was reviewed and meets the regulation requirement. LPA review of the Facility Personnel Summary Report revealed all staff are fingerprint cleared. Staff met the SB 792, record of immunization are on file. Children's files were randomly reviewed and found complete. Center is not providing Incidental Medical Services (IMS) 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.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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 2

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 CLUBHOUSE, THE	FACILITY NUMBER: 406208150
	VISIT DATE: 11/13/2019

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
26
27
28
29
30
31
32

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

During today's inspection, no deficiencies were cited.

LPA observed Licensee posted the Notice of Site Visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2