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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215266
Report Date: 08/30/2023
Date Signed: 08/30/2023 12:07:16 PM


Document Has Been Signed on 08/30/2023 12:07 PM - It Cannot Be Edited

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:62CENSUS: 37DATE:
08/30/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Kimberly BarrientosTIME COMPLETED:
12:15 PM
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On 8/30/23, at 11:20 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management Inspection of the abovementioned Child Care Center (CCC) to authorize the use of a remodeled outdoor play area. The LPA met with Kimberly Barrientos, Assistant Director of the CCC and explained the purpose of the inspection. LPA, in the company of Assistant Director, toured the interior and exterior of the CCC. At the time of the inspection, LPA observed 37 children in care along with 8 teachers (cleared and associated) providing care and supervision.

The outdoor play area is enclosed by chain link fencing and the footing in the area is varied. The fencing height is sufficient. The fences entry/exits are secure. The outdoor play area contains play structures which are rated for the use of children 2-12 years of age. The play structures have cushioning material in the form of a rubber matted surface (pour in place) which absorb falls.

In view of the aforementioned, the CCC is granted permission to use the remodeled play structure for child care services/activities.

LPA notes the square footage of the outdoor play area is unchanged.

A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the facility representative Kimberly Barrientos.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023
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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