406213788-2-3-2022-17-CC-EBAY-CBASUZ-20220203131200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406213788
Report Date: 02/03/2022
Date Signed: 02/03/2022 01:12:06 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:	CAL POLY PRESCHOOL LAB		FACILITY NUMBER:	406213788
ADMINISTRATOR:	CLARKSON, PATRICIA		FACILITY TYPE:	850
ADDRESS:	1 GRAND AVENUE		TELEPHONE:	(805) 756-2220
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93407
CAPACITY:	30	CENSUS: 14	DATE:	02/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Patricia Clarkson		TIME COMPLETED:	01:00 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 2/3/22, at 9:45 AM , Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required Inspection the abovementioned Child Care Center (CCC). The LPA met with Patricia Clarkson, (Director) and Kari Applegate (Master Teacher) of the CCC and explained the purpose of the inspection. LPA, in the company of Director and Master Teacher, toured the interior and exterior of the CCC. The center operates from 8:30 AM to 4:30 PM, Monday - Friday. The preschool uses one great room for child care services, along with upper and lower outdoor activity areas. LPA observed 14 children on site during the inspection along with 4 (cleared and associated) teachers providing care and supervision.

The room used for child care is clean and organized. The room has age appropriate toys and furnishings available for children. The CCC has carbon monoxide detector in the great room which was tested at 9:45 AM and found to be operable.

The restroom used for care is in safe and sanitary operating condition. Parents of children in care provide snacks and lunches. CCC staff inspect the children's lunches to ensure the given lunches contain healthy items from the essential food groups. There is available drinking water for children both inside the classroom and outside in the play area. Disinfectants, cleaning solutions, sharps and medications are stored on and in elevated cabinets throughout the CCC. Each location is inaccessible to children in care.

The CCC's outdoor playground areas are enclosed by wrought iron fencing. The fences' entry/exit gates are secured. LPA observed age appropriate toys and play equipment in the play areas. LPA also observed numerous shed in the outdoor activity areas which were secured by lock and contained CCC supplies. The toys and play equipment in the outdoor areas are in suitable condition and free of sharp, loose or pointed objects. The play structures in the playground areas have cushioning materials to absorb falls and an abundance of shade created by trees and building overhangs. No bodies of water were observed on site. Waste receptacles with tight fitting covers were observed throughout the CCC.

(CONT.809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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: CAL POLY PRESCHOOL LAB	FACILITY NUMBER: 406213788
	VISIT DATE: 02/03/2022

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

LPA reviewed posted menus along with licensing required notices and documents posted predominately in the CCC. LPA reviewed the facility's Sign in Sign Out forms upon arrival at the CCC. LPA noted the arrival times of children in care and as well as notations from authorized representatives/parents on the forms

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. Staff records were reviewed and contained pediatric CPR and First Aid certifications as well as Mandated Report certifications. Director informed LPA no firearm or ammunition are stored on the premises.

This facility provides Incidental Medical Services – IMS, however there are no children using IMS services at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Facility representative 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 Facility representative Patricia Clarkson.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2