406212578-12-22-2021-17-CC-GRES-C9XT5J-20211222132538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406212578
Report Date: 12/22/2021
Date Signed: 12/22/2021 01:25:48 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:	NORTH COUNTY CHRISTIAN SCHOOL - PRESCHOOL		FACILITY NUMBER:	406212578
ADMINISTRATOR:	DINA DALE		FACILITY TYPE:	850
ADDRESS:	6225 ATASCADERO MALL		TELEPHONE:	(805) 602-6648
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	30	CENSUS: 19	DATE:	12/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Dina Dale		TIME COMPLETED:	01:30 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	On December 22, 2021 Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Annual Required inspection. Prior to inspection, LPA asked health screening questions related to COVID 19, Director's response indicate there was no exposure on site. LPA explained the purpose of the inspection. The center operates Monday to Friday from 7:00 AM to 5:30 PM Center is located at Atascadero Bible Church (ABC) occupying rooms E201 and E202. LPA observed required Licensing forms were posted on the wall by the entrance of each classroom. There are two restrooms, 2 toilets and 6 sinks. The classrooms are equipped with age appropriate games, activities, and furniture. Carbon monoxide was tested and found functional. The menu is posted on the wall. Center provides 2 snacks per day. The center uses the church play ground with age appropriate play equipment. Playground is enclosed by an appropriate fence. Water pitcher and disposable cups provide drinking water for children during outside playtime. Individual refillable water bottle provides drinking water in the classroom. A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information and medical assessments. A review of staff records on 12/22/2021 indicates that all facility staff have criminal record clearance. CPR and First Aid expired on 8/6/2023. Sign in and sign out record meets the regulation requirements. All Staff have current Mandated Reporter Training Certificates. LPA observed that Staff #3 does not have Health Screening Report (LIC 503) on file. During today's inspection deficiency was cited under Title 22 Division 12 of California Code of Regulations.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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: NORTH COUNTY CHRISTIAN SCHOOL - PRESCHOOL	FACILITY NUMBER: 406212578
	VISIT DATE: 12/22/2021

NARRATIVE

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LPA observed that day care children were not wearing face covering. LPA interviewed Director, Staff 2 and Staff 4 who stated they encourage and teach children to wear face mask, however not all the children would like to wear face mask. Director stated they will continue to encourage children to wear face covering. A Technical Violation on Personal Rights was issued.

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 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.

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.

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

Exit interview conducted and report was reviewed with the Director, Dina Dale.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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: NORTH COUNTY CHRISTIAN SCHOOL - PRESCHOOL	FACILITY NUMBER: 406212578
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review , the licensee did not comply with the section cited above, Staff # 3 does not have the Health Screening Report (LIC503) on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/14/2022
	Plan of Correction
1 2 3 4	Director agreed to submit the Staff # 3 Health Screening on or beofre 1/14/2021 to CCLD. Director will submit a written plan of correction to ensure that all will submit LIC 503 staff prior to employment or 7 days after employment.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC809 (FAS) - (06/04)

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