421711775-3-22-2023-17-CC-MBRT-CQ6N95-20230322101523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421711775
Report Date: 03/22/2023
Date Signed: 03/22/2023 10:15:32 AM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/22/2023 10:15 AM - 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:	SBSD - ADAMS STATE PRESCHOOL		FACILITY NUMBER:	421711775
ADMINISTRATOR:	MICHELLE ROBERTSON		FACILITY TYPE:	850
ADDRESS:	2701 LAS POSITAS ROAD		TELEPHONE:	(805) 569-2232
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93103
CAPACITY:	20	CENSUS: 13	DATE:	03/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:33 AM
MET WITH:	Kelly Mensha		TIME COMPLETED:	10:30 AM

NARRATIVE

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On March 22^nd, 2023, at 8:33AM, Licensing Program Analysts (LPA) Rosie Breault and Daniel Venegas conducted an unannounced Annual/Random inspection. LPAs met with site supervisor Kelly Mendhsa and advised her the purpose of the inspection. Site supervisor was present during tour of the inspection. LPAs inspected both inside and out. The center operates from 8:00AM – 11:00AM Monday through Friday. There were thirteen (13) children in care at the time of the inspection, one (1) teacher and one (1) assistant.

LPAs observed required licensing documents mounted on the wall at the entrance of the facility and the menu for the month of March 2023. Facility uses written logs for sign in and out purposes. The facility utilizes one (1) classroom. Classroom has age-appropriate toys and furniture readily accessible for children in care and offers ample ventilation. LPAs observed first aid kits available for use in classrooms. Children use their own water bottles and LPAs observed classroom to have 2 (two) toilets, 2 (two) hand washing sinks in bathroom, and an additional handwashing sink in the classroom and outdoors which were functioning at the time of the inspection. LPAs observed all cleaning compounds, disinfectants, sharps, and tools to be inaccessible to children and / or locked in a cabinet. Fire extinguisher was last serviced August 8^th, 2022. Last fire/disaster drill was conducted on 11/28/2022. Site supervisor states no firearms or ammunition present on property.

The outdoor area has an ample amount of space for children to play, soft cushioning with appropriate toys, and a shaded area. No bodies of water are present.

Incident Medical Services are being provided. LPAs observed one locked medical box, inaccessible to children, containing child’s medication with unaltered label, and not expired. Required medication paperwork present and current.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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: SBSD - ADAMS STATE PRESCHOOL	FACILITY NUMBER: 421711775
	VISIT DATE: 03/22/2023

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A sampling of children and staff records were reviewed. LPAs 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. Teacher meets the required qualifications. Teacher present has current Pediatric CPR/First-Aid certificates that are valid until 10/21/2024. Teachers present has current Mandated Reporter certificates that is valid until 7/1/2024.

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.

No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the site supervisor

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 Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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