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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215634
Report Date: 01/08/2020
Date Signed: 01/08/2020 11:07:35 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:HEARTS AND HANDS CHRISTIAN CHILDCARE & PSFACILITY NUMBER:
406215634
ADMINISTRATOR:MICHELLE SKOGENFACILITY TYPE:
850
ADDRESS:112 ORCHARD ROADTELEPHONE:
(408) 748-3500
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:60CENSUS: 24DATE:
01/08/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Debra PattersonTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christian Patterson made an unannounced inspection to the facility for the purpose of conducting an ANNUAL/RANDOM inspection. LPA met with Director Debra Patterson and explained the purpose of the inspection. The facility operates Monday- Friday from 6:30am-6:30pm. There were 24 children present. A tour of the facility was made both inside and outside. The classrooms were observed to have age appropriate furniture/equipment. The restrooms were observed to be clean and free of toxins. There is a functioning smoke/carbon monoxide detector in each classroom. All required State forms and daily menu were posted. The outdoor play area is completely fenced. LPA observed age appropriate equipment. Drinking water is available inside and outside. The last disaster drill was completed on 12/26/19.

Teacher files reviewed. Teacher's Medical Health Records were reviewed. LPA observed one staff file to be missing proof of immunizations. At least one teacher in each classroom has valid Pediatric CPR/First Aid which expires on 10/2021. Center staff have completed AB1207 Mandated Reporter Training. Sign in and sign out verified and matched census. Children's files were reviewed and found to be complete.

Incidental Medical Services (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
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PS
FACILITY NUMBER: 406215634
VISIT DATE: 01/08/2020
NARRATIVE
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Director is reminded that they are responsible for knowing the regulations for a Child Care Center and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed and provided Director with Infant Safe Sleep and Effects of Lead Exposure Brochures


Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D). The Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The LIC 9213 (Notice of Site visit) was posted during today's visit.

The LIC 9213 (Notice of Site visit) was posted during today's visit.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PS
FACILITY NUMBER: 406215634
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2020
Section Cited

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1596.7995(a)(1)- Employees or volunteers at day care center; immunization requirements; .. a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.

This requirement was not met as evidenced by:
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by records review and interview with Director reveals that staff #5 did not have verification of all required immunizations. This poses a potential risk to the safety of the children.
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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: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2020
LIC809 (FAS) - (06/04)
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