<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214085
Report Date: 02/12/2020
Date Signed: 02/12/2020 01:31:16 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:SHEPHERD'S CHRISTIAN PRESCHOOLFACILITY NUMBER:
406214085
ADMINISTRATOR:TERESA A. SHEPHERDFACILITY TYPE:
850
ADDRESS:4410 PORTOLA ROADTELEPHONE:
(805) 305-1422
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:20CENSUS: 16DATE:
02/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Teresa A. ShepherdTIME 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
(3) Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Annual Random and met with Director, Teresa Shepherd. The purpose of the visit was discussed. There were 16 preschool children 3 teachers present. The center was toured and inside and out. There were nobodies of water observed. Director stated there are no guns nor ammunition in the Center.

During the tour, following were observed:
  • Classroom is equipped with age and size appropriate furniture and equipment.
  • Personal water bottle provides the drinking water in the indoor space.
  • An adequate amount of wood chip cushioning is placed under play structure
  • Playground is enclosed with an appropriate fence.
  • Drinking water is provided in the outdoor area with a drinking fountain
  • Carbon monoxide is present.
  • Menus and required licensing forms are posted in the prominent location.
  • Required Licensing forms are posted in a prominent location
  • Bathroom was observed clean and free of toxins.
  • Hazardous items and cleaning materials are stored inaccessible to the children in care.

Continued on 809 C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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: SHEPHERD'S CHRISTIAN PRESCHOOL
FACILITY NUMBER: 406214085
VISIT DATE: 02/12/2020
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
A review of staff records and children's records were conducted. CPR and
First Aid expires on 08/2020. Review of staff records indicates that all staff have criminal record clearance. Director and staff have met the SB 792 requirements. AB1207, Mandated Reporter Training of Staff # 1 and Staff # 2 expired on 11/29/2019. Director was reminded that AB 1207 Training must be taken every two years. LPA discussed the Effects of Lead Exposure and provided flyer for distribution to parents of day care children.

The Center is not providing Incidental Medical Services (IMS) 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

In the areas evaluated, deficiency was cited under Health and Safety Code. Appeal Rights Given.

LPA observed director posted the notice of Site Visit.

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

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 2 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: SHEPHERD'S CHRISTIAN PRESCHOOL
FACILITY NUMBER: 406214085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2020
Section Cited

1
2
3
4
5
6
7
(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility ...and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Staff 1 and Staff 2 have not renewed the AB 1207 training, Mandated Repoter Training. It exoired on 11/29/2019. This poses a potential risk to health and safety of children.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: 02/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3