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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215266
Report Date: 08/06/2021
Date Signed: 08/06/2021 10:45:21 AM

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:COUNTRY COTTAGE PRESCHOOLFACILITY NUMBER:
406215266
ADMINISTRATOR:BRIANNA MALLORYFACILITY TYPE:
850
ADDRESS:2075 JOHNSON AVENUETELEPHONE:
(805) 235-2153
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:50CENSUS: 36DATE:
08/06/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Brianna MalloryTIME COMPLETED:
10:45 AM
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On 8/6/21, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management Inspection of the abovementioned Child Care Center (CCC) to assess a request for a change of capacity. LPA notes the current capacity of the CCC is 50 children. LPA met with Brianna Mallory to initiate the inspection. LPA notes 36 children are present during the inspection, along with 7 teachers (associated and cleared).

Upon explaining the purpose and nature of the inspection, LPA toured and measured the exterior and interior of the CCC which include the three classrooms (Room 1- ages 4 and 5, Room 2- ages 2 and 3 and Room 3- age 3) and outdoor play areas (2).

The indoor area square footage meets the requirement for a total of 63 children while the outdoor play area square footage meets the requirement for 162 children. LPA notes the sinks (5) and toilets (8) in the CCC meets the requirement or 75 children. CCLD received a fire clearance for an additional 12 children from the San Luis Obispo City Fire Department of 7/29/21. The aforementioned affords the CCC a capacity of 62 in light of the fire clearance.

In consideration of the facility's measurement as well fire clearance, the CCC is licensed for 62 children, forthwith.

LPA forwarded a Notice of Site Visit which is to be 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 $100.00 may apply.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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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