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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406212971
Report Date: 10/15/2021
Date Signed: 10/15/2021 05:40:15 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:KIDZ KORNER PRESCHOOLFACILITY NUMBER:
406212971
ADMINISTRATOR:CAMILLE BRUNNERFACILITY TYPE:
850
ADDRESS:3396 JOHNSON AVE.TELEPHONE:
(805) 544-5194
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:60CENSUS: 23DATE:
10/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Camille BrunnerTIME COMPLETED:
02:45 PM
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On 10/15/21 at 12:45 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required Inspection the abovementioned Child Care Center (CCC). The LPA met with Camille Brunner, Director of the CCC and explained the purpose of the inspection. The LPA, in the company of the Director, toured the interior and exterior of the CCC. The CCC operates from 7:30 AM to 5:30 PM, Monday - Friday. The CCC is on the grounds of the Church of the Nazarene. The CCC uses four classrooms ("Jet" Room - ages 4-5, "Chopper" Room- ages 2 and 3, "Chu Chu" Room- ages 3 and four and the "Tug Boat" Room ages 18 months -2 years) for care. LPA observed 23 children on site along with 5 teachers (cleared and associated) providing supervision. LPA notes all children were napping at arrival.

All classrooms of the CCC were clean and organized. The classrooms have age appropriate toys and furnishings available for children in care. All classrooms have operable combination carbon monoxide/smoke detectors. LPA tested a combination carbon monoxide/smoke detector in the Chu Chu room at 1:50 PM. The restrooms of the CCC used from care are observed in safe and sanitary operating condition. LPA observed operable refrigerator in each classroom which contained children's lunches. The lunches in the refrigerator are labeled. LPA notes snacks are provided by the CCC, while children in care bring lunches from their homes. The CCC reminds parent to provide healthy lunches which contain the essential food groups. There is available drinking water for children both inside the classroom and outside in the play area. LPA reviewed posted menu in the classrooms while licensing required notices and documents are posted near the entry of each classroom. LPA observed sign In/out forms and found the documentation to be completed appropriately.

Disinfectants and cleaning solutions are observed in secured locations in each classroom which are inaccessible to children in care. Director notes no medication is on site, but when medication is present it is stored in a secure location. Waste receptacles with tight fitting covers are observed throughout the CCC.

The CCC has two outdoor playground areas. The playground area for 2 to 3 year olds is in the courtyard of the classrooms. The playground area for older children is in south end of the CCC and enclosed by cinder (CONT. 809-C)

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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: KIDZ KORNER PRESCHOOL
FACILITY NUMBER: 406212971
VISIT DATE: 10/15/2021
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block and chain link fencing. The fences' entry/exit gates are secured. LPA observed age appropriate toys and play equipment in each of the the play areas. The toys and play equipment observed are in suitable condition and free of sharp, loose or pointed objects. The play structures in the playground areas have adequate cushioning materials to absorb falls and an abundance of shade created by trees, shade covering and building overhangs. No bodies of water are observed on site.

A sampling of staff and children's records are reviewed. The children’s records were complete and found to contain emergency contact information as well as immunization records. Staff member's records were reviewed and contained current CPR and First Aid certifications and well as Mandated Reporter certifications and qualifications. Director informed LPA no firearm or ammunition is stored on site.



This CCC provides Incidental Medical Services (IMS) however the are not children on site using IMS currently. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA discussed COVID 19 guidance and best practices with the Director. Director ia reminded that it is Director's responsibility to know the regulations for a CCC which can be accessed on-line at www.ccld.ca.gov



In areas evaluated, there were no deficiencies cited at this time.

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 APPLY

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC809 (FAS) - (06/04)
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