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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406208150
Report Date: 08/03/2021
Date Signed: 08/03/2021 04:28:28 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, THEFACILITY NUMBER:
406208150
ADMINISTRATOR:JEANNE HUNTFACILITY TYPE:
840
ADDRESS:714 CROCKER ST.TELEPHONE:
(805) 434-1188
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY:15CENSUS: 10DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Gina GoetschTIME COMPLETED:
01:30 PM
NARRATIVE
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On August 3, 2021, Licensing Program Analysts (LPA) Gigi Reyes and Licensing Program Manager (LPM) Maria Mueller conducted an unannounced Required Annual inspection of the above mentioned Child Care Center (CCC). Prior to inspection, LPA asked pre screening questions related to COVID 19, Director's responses indicate there was no COVID exposure on site. LPA met with Gina Goetsch, Director and Jeanne Hunt, Licensee of the CCC and explained the nature of the inspection. LPA, in the company of the Director toured the interior and exterior of the CCC. The 10 school age children and one teacher were at the recreational park during the inspection. The CCC operates from 8:30 AM to 4:00 PM, Monday thru Friday.

During the tour, the following was observed, classroom is adequately equipped with age and size appropriate furniture and equipment. Water cooler supplies drinking water in the indoor activity space. Playground is enclosed by an appropriate fence. Outdoor activity area is equipped with age and size appropriate equipment. An adequate amount of cushioning material is in place under play equipment. Adequate shade is available. Drinking water is provided in the outdoor play area by a water cooler and individual water bottle.

A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well as medical assessments. A review of staff records on 8/3/2021 indicates that all facility staff have criminal record clearance. CPR and First Aid expired on 6/7/2021. Sign in and sign out record meets the regulation requirements. AB 1207 Mandated Reporter Training Certificate expires on 12/13/2021.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 3
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: 08/03/2021
NARRATIVE
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Director noted no firearms or ammunition is stored on site.

Incidental Medical Services (IMS) policy was discussed. 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.htmhttp://www.ada.gov/childqanda.htm

In areas evaluated, deficiency was cited under Title 22 Division 12 and Health and Safety Code.


Appeal Rights were provided to Licensee and Director

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL BE ASSESSED.




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

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2021
Section Cited

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101216(f) Personnel Requirement
At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
This requirment is not met as evidenced
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During file review, it was observed that CPR and First Aid expired on 6/7/2021. Director stated that all staff have registered to renew the CPR and First Aid Training.
This poses a potential 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: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3