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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421708110
Report Date: 01/25/2023
Date Signed: 01/25/2023 02:40:35 PM


Document Has Been Signed on 01/25/2023 02:40 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:GOOD SHEPHERD PRE-SCHOOLFACILITY NUMBER:
421708110
ADMINISTRATOR:KATIE ECKERTFACILITY TYPE:
850
ADDRESS:380 NORTH FAIRVIEW AVENUETELEPHONE:
(805) 967-6101
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:50CENSUS: 40DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Katie EckertTIME COMPLETED:
02:50 PM
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On January 25th 2023, at 12:00PM Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with facility director Katie Eckert and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. The facility operates Monday – Friday 7:45AM – 4:00PM. At the time of the inspections there were forty (40) children and (5) staff, not including director.

LPA observed required licensing documents in a prominent location and daily schedule. Facility does not provide food services to children. Facility uses a written log for the purposes of signing in and out. Last fire/disaster drill was conducted on October 27th and 28th of 2022. Facility is currently using two (2) classrooms for care and supervision, both have age-appropriate toys and furniture readily accessible for children in care and offers ample ventilation. Children nap on mats which are disinfected daily, and individual bedding stored separately. LPA observed first aid kit available for use in classroom. Children use their own water bottles which are labeled with their names. LPA observed all cleaning compounds, disinfectants, sharps, and tools to be inaccessible to children and / or locked in a cabinet. Facility provides ample toilets/urinals and sinks for children to use.

The outdoor area has an ample amount of space for children to play with appropriate toys, equipment, and shaded areas. No bodies of water are present, and no firearms or ammunition are present.

Incident Medical Services are currently not being provided at this time.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. LPA observed staff files to be complete and current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Teachers meet the required qualifications. Teacher present have current Pediatric CPR/First-Aid certificate valid through 8/20/23, teachers present have current Mandated Reporter certificates that are valid.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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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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: GOOD SHEPHERD PRE-SCHOOL
FACILITY NUMBER: 421708110
VISIT DATE: 01/25/2023
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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 follow 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

LPA provided courtesy Emergency Disaster Drill Log to director

Technical advisory provided to director and no deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the Director.

THE NOTICE OF SITE VISIT WAS 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 OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC809 (FAS) - (06/04)
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